From Crossfitters to marathon runners to active individuals going out for their evening walk, lateral hip and knee pain can be a very common experience.
One rationale for this pain may be IT Band Syndrome, more commonly referred to as ITBS.
What is the IT band?
The IT (short for iliotibial) band is a dense band of connective tissue extending from the outside of the upper hip and glute muscles, down the thigh, attaching to the outside portion of the knee.
It’s primary role is to be a connector of the lateral hip muscles to the knee in order to provide and supplement stability to the knee. At times this band can become inflamed at the hip or knee and is often referred to as ITBS.
Who gets IT Band Pain Syndrome?
ITBS is often labeled an “overuse injury” and is associated with those who are involved in activities that have a high volume of work that stresses stabilization at the hip and knee.
Volume = Load (weight) / Repetitions (amount of times moving said weight)
This means it can go all along the spectrum, from low load constant reps of runners, to high load less reps of heavy barbell work, and everything in between.
Most commonly it is seen in those who have had a recent increase in volume.
At the start of ITBS, individuals are able to continue their activities by ignoring the pain, occurring only at the beginning or end of activity. When untreated, the pain increases in duration, encompassing the whole activity, and starts to limit participation in any extended use of the legs, beyond the activity initially associated with the pain. The longer the pain goes, the more compensations can begin to occur.
Just one of these compensations can be the loss of strength in one leg leading to the overstressing of the other. This pushing through the pain mentality can lead to both sides becoming inflamed or transferring pain to the joint above (the low back) and below (the ankle) the initial painful area.
What causes ITBS?
One of the primary causes behind IT Band syndrome is the lack of lateral hip and glute strength or coordination in the stability of the knee.
Try these steps to progress towards a healthy IT Band.
Step 1: Test: Strength and Coordination:
When the lateral hip musculature is either weak or uncoordinated, the level of stress that the muscles are supposed to take gets transferred to the IT band itself. Extended use of this mechanism can lead to irritation.
To test your strength and coordination enter the lateral Step down test.
Repeat the below for 5 reps.
Using arm for balance: +1
Needing to lean trunk to maintain balance: +1
Loss of level pelvis: +1
Knee inside of the second toe: +1
Knee inside of the entire foot: +2
Unable to control descent to bottom: +1
Add up your score:
Good Quality Movement: 0-1
Medium Quality Movement: 2-3
Poor Quality Movement: 4+
How did you do?
Step 2: Pain Relief with Retraining Glutes
While most people will turn to foam rolling the IT band, this effect can be temporary, if not very painful to perform. Instead we incorporate isometrics into our rehab with our active individuals.
Isometrics help in three distinct ways:
- Due to their longer holds they assist in helping your brain’s coordination and usage of the muscle (technically speaking increases the homunculus representation of the area in the brain)
- They increase strength
- They decreased pain when done in the appropriate dosage
With the glutes being the primary muscle controlling force through the IT band this is where we start focusing the forces.
It is important to note that despite what you may have been told this does not mean your glutes are “asleep.” Essentially this is just another form of coordination.
Where most people will focus on the extensions component of glutes, due to the IT band’s orientation on the side of the hip, we focus on the external rotation (pushing knee out) function of the glutes.
Here are two of the most common we perform in clinic.
Step 3: Assume Coordination and Build
I have found that patients who come to see me have often been told they are weak in some region and that is why they struggle with certain motions, only to go test the musculature and find them strong.
As humans we move very regularly and are usually inherently strong, but we have adapted to the way that we move.
Rather than assuming you are weak, first try practicing or adjust the load. Can you perform the step up test better with more than 5 reps of practice? Maybe the load is too much and you can do it with a lesser height?
If you can coordinate the above test well you may simply need to add weight/variety to the exercise.
See below for our heel tap progression to help build that single leg coordination!
Bonus: Add External Feedback
If you are still noticing trouble with controlling your knee even when reducing the work your legs are doing from single to double leg work, or noticing difficulties in any position it may be time to add a band.
Our body has a natural response to resist pressures placed on it. By adding a band pulling the knee inward we can get the protective systems at the knee and hips involved to help learn knee stabilization.
The goal however, is to be able to get rid of the band as fast as possible, to have your body do it innately.
See below for a progression that may help you do this:
*these can all be done with either a band wrapped around knees or a band anchored to a stable object*
The truth is the human body is very complicated, and much like everyone has a unique look and fingerprint on the outside, we are all very unique on the inside.
These exercises can not work for everyone. Each individuals’ care needs to be based on their unique pain experiences.
While we have covered two prominent rationales for hip pain that could be attributed to the IT Band, other factors may play a role: foot coordination, ankle range of motion and strength, quad strength, hip range of motion, etc.
If you’ve tried the above and are noticing inconsistent responses it’s time to take the necessary step of getting individualized care.
Each person’s pain experience is unique and should be treated as such!
Maybe you’ve had “physical therapy” before and it didn’t work.
Did they go beyond simple stretches or exercises and truly build new patterns of movement and strength with you?
Did they go beyond just pain relief and address the root cause?
Unfortunately, if you are seen in the mainstream healthcare system you may not have been given enough time with your doctor to get beyond the cookie cutter care.
We specialize in helping active individuals get back to the sports and activities they love without taking time off or undergoing invasive treatments.
Real People. Real Pain. Real Work. Real Results.
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🚫The content in this is NOT medical or health advice and is intended for educational and entertainment purposes only. See a healthcare professional if you have any questions about your individual healthcare needs.🚫