Preventing IT Band Syndrome

IT Band Syndrome is one of the most common causes of knee pain in runners. It is an overuse injury caused by repetitive friction of the iliotibial band across the Lateral Epicondyle (see image below). This syndrome presents as lateral (outside) knee pain due to tightness of the ITB and hip abductors. As a result of movement of the band during flexion and extension of the knee and hip, a tight band could be responsible for the inflammation at the knee or even the hip, or along the IT Band.

The main physical causes of this condition are:

• Tight IT Band.
• Altered foot function: Excessively flat feet cause the lower leg to internally rotate excessively, adding a stretch tension to the IT Band.
• Decreased Glute Medius/Maximus function.
• Overactive TFL muscle due to lack of Gluteus Medius function
• A weak or inactive Vastus Medials (VMO). This is the inside muscle group of the quadriceps and tends to become weak on people.
• Medial (inward) knee migration during walking/running.
• Leg length discrepancy.
• Tightness of hamstrings/Quads/Calves

Other non-biomechanical reasons for the condition can be improper running technique, worn-out or improper running shoes, hill running, canted running surfaces, and increasing mileage too fast. If you feel any of the non-biomechanical reasons may be an issue, please confer with your running store or coach.

1-Leg Stance Test for hip/foot/ankle instability      

Gluteus Medius Activation for hip stability

^{Hip instability causing knee inward migration This places excessive stretch on the IT Band}

^{Foam Rolling for IT Band}

From a physical standpoint, the best way to prevent IT Band Syndrome is to correct the causes by performing stretches and exercises to correct any of these above dysfunction. Stretching or foam rolling for the IT band, Hamstrings, Calves and Quads is necessary. Secondly, you need to be evaluated to determine if you have excessively flat arches or excessive pronation of the ankle. If you have flat feet, an orthotic may be beneficial. Lastly, strengthening of the hip stabilizers (glutes) and proprioception training of the ankle are recommended.

If you are, or in the future, suffer from IT Band Syndrome, conservative treatment usually does a great job of freeing you from your pain. In our practice we utilize Active Release Technique (www.activerelease.com), Graston Technique (www.grastontechnique.com) and Kinesio Taping along with other modalities to treat the pain and prevent it from coming back. I recommend you familiarize yourself with the above techniques if you are a runner; they are the top conservative treatment methods running related over-use injuries.

Graston Technique for Treatment of Injuries

Graston Technique® utilizes patented stainless steel instruments, uniquely shaped, to treat different areas of the body. The weight and design of the various instruments allow clinicians to effectively treat deep tissue dysfunctions, while preventing the stress associated with manual therapy on their own extremities.

When the instruments contact the adhesions, the patient and clinician will notice a distinct feeling of going over a “speed bump” or gravel-like grittiness. Graston Technique breaks down and releases these “speed bumps” or scar tissue. Over time, this process generally will reduce or eliminate the adhered fibers, restoring function and eliminating the pain associated with it.

Injuries will be treated at the site of pain or scar tissue; however, clinicians will scan the surrounding areas, following the kinetic chain to find if there is an underlying cause of the injury. Often the clinician will treat the region in a position or movement that causes the pain or mimics the sports movement pattern. For example, a golfer who has lead shoulder pain at the top of the backswing and into the downswing may be treated in these positions and movements. Also, a key benefit to patients is they are able to engage in everyday activity or sport during treatment.