The Truth About IT band Syndrome

IT band

It’s NOT a FRICTION SYNDROME

The purpose of this article is to inform readers that commonly held beliefs regarding ITBS (iliotibial band syndrome) lack evidence and miss the target on treatment. As dedicated exercisers and competitors doing your part to maintain your health, longevity, and push the limits of human performance, you deserve better knowledge and empowerment to keep going. Gaining control over your pain starts with understanding why.

Point 1. Make sure your pain is not caused by something else. Anybody can point to a body part that is painful and give it a name (i.e. runner’s knee and ITBS). The cause of your symptoms is what is valuable to know, and in order understand the cause, the entire movement system (the human body) should be assessed. Lateral thigh and knee pain has potential pain referral from other structures such as the back or hip, not to mention the myriad movement impairments that can occur from the great toe through the spine. Listing differential diagnoses and explaining the relevance of impairments exceeds the scope of this article, but beware, IT band syndrome can be a wolf in sheep clothing. Seeing your physical therapist is an inexpensive first step to establish the factors giving rise to your pain, and ruling out other sources of pain referral.

Point 2. Despite the ‘word on the street,’ IT band syndrome is NOT a friction syndrome or a bursitis. Anatomic research shows there is not even a bursa there!1,2 And, despite the common belief that the IT band tendon slides and rubs back and forth over a bone in the knee, the functional anatomy debunks this phenomenon. Anatomical research has revealed that two slips of tendon with different bony attachments are tensioned at different ranges of knee motion giving the appearance of a band of tissue sliding back and forth. 2  What can occur is compression of a highly vascularized fat pad in that outside part of the knee, which may or may not be the anatomical source of pain.1,2

Well, what about stretching? IT band syndrome is caused by a tight IT band, right?

Point 3. It’s highly unlikely your IT band is too short. Research shows that clinically identified “tight IT bands” are not predictive of IT band pain anyway.3 What’s more, the typical static stretching does not actually lengthen the iliotibial fascia, so why is everybody stretching so much? Let’s review functional anatomy again. Under your skin, your thigh muscles are circumferentially wrapped in a Saran wrap-like tissue called fascia. That fascia is connected all the way down to the back of your thigh bone, running nearly the entire length of the thigh bone. The IT band is simply a thickening of that tissue, and it is not moving anywhere. Consider that a maximal muscle contraction of the TFL causes a 0.2% change in IT band length.1 Furthermore, research shows you are much more likely to be relaxing and lengthening the supportive hip muscles…you know, the muscles you are supposed to be strengthening (see point 4).   Therefore, stretching can actually be counter-productive despite how good it feels while doing it.

Point 4. Strengthening hip girdle muscles has scientific support.4,5 But there is a caveat. It is really easy to strengthen muscles that are already strong, and it is really difficult to strengthen muscles that are relatively weak. It is import to first reeducate your nervous system to recruit specific muscles before strengthening. My mentor always says, “Just because you wear your muscles, does not mean you use them.” So as long as you are recruiting specifically weak muscles, have at it, Jane Fonda. Though not a cure-all, strength and endurance of the hip and pelvic girdle contributes to improved alignment of the lower limb joints while running. What is often the missing component, however, is functional coordination of these muscles while running.

Point 5. Sorry, there is no secret formula for treating IT band syndrome. Passive modalities such as ice, heat, or massage may confuse your nervous system long enough to experience short-lived relief, but the pain will return unless you take a holistic approach to correcting movement patterns. About the foam roller, my professional opinion is that it can help mobilize adhered tissue layers and relieve painful myofascial trigger points (small painful bundles of muscle and connective tissue). However, if the impaired movement is not remedied, those bundles of joy will return.

Point 6. Please, do not give up without a fight. If foam rolling, stretching, icing and general strengthening have been unsuccessful, you now have a better understanding why. So the next time someone proclaimes, “Oh, you just have a tight IT band!” you know better.

My challenge to those who accept that pain is part of who you are as a runner, make time for yourself to learn about how you move. Subtle tweaks can make big changes. Movement is vital to your health, and the precision of your movement is vital to the health of your movement system. Remember, you only have one.

Citations

  1. Falvey EC, Clark, RA, Franklyn-Miller A, Bryant AL, Briggs C, & McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports 2010; 20:580-587.
  2. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport 2007; 10: 74–76.
  3. Devan MR, Pescatello LS, Faghir P, Anderson J. A Prospective Study of Overuse Knee Injuries Among Female Athletes with Muscle Imbalances and Structural Abnormalities. Journal of Athletic Training 2004; 39:263-267.
  4. Nohren B, Davis I, Hamill J. Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech 2007; 22:951-956.

Article Published in March 2014 issue of Northwest Runner Magazine

Check out Frank Netter’s Atlas of Human Anatomy and related website

Weekly Workout: The “Form Fartlek”

Pronounced just as it is spelled, the term fartlek is Swedish for ‘speed play.’ Running athletes have used fartlek training sessions as a way to perform an unstructured and free-spirited workout blending bouts of faster running separated by recovery bouts. Often thought of in terms of physiological benefits of training, another purpose for the fartlek can be to improve running form (a.k.a. biomechanical factors). I use the term ‘Form Fartlek’ with clients/athletes to focus attention on improving biomechanical flaws while also getting the benefit of improving running economy.

Form fartlek workouts can be utilized by anyone at any level of running. Even elite athletes dedicate substantial time to improving/maintaining running form, especially under conditions of fatigue. The form fartlek is the workout to improve biomechanics. The paramount feature that separates it from other workouts is brief phases of intense focus on body awareness without experiencing form fatigue. It is a steppingstone to more intense training sessions that challenge biomechanics with accumulating fatigue.

The form fartlek can be structured however to adapt to any fitness level. For the average runner who participates in 5k’s through half-marathons, I like to use a somewhat structured approach (less like a true fartlek) by using a 1-minute stride phase at 10k-1/2 marathon pace/effort and 1-minute rest phase running at a recovery run pace/effort with the same cadence (steps/minute) in both phases. Keeping stride phases short allows for bursts of intense mental focus and body awareness. The rest phase needs to be long enough to allow full recovery for the form fartlek. For less fit individuals, doubling the recovery time or decreasing the stride phase time below 40 seconds may be necessary. Accumulating too much fatigue will force form failure, which is not the goal of this workout. If form failure occurs, the workout is terminated and the intensity was overdone.

When beginning form fartleking, pick one biomechanical feature to work on at a time. For example, if the goal is to improve trunk lean, focus on that only. If the goal is to improve cadence, focus on cadence only. As your performance and body awareness related to these improve, layers of complexity can be layered on. Finding the cue to do that may be different for each individual.

Knowing what aspects of one’s form to focus on is challenging making the process of finding the proper cues for each individual to gain body awareness essential. To gather a realistic impression of an individual’s biomechanical strengths and weaknesses, I use a combination of gait analysis on a treadmill using three planes of video (normal and slow motion), running outdoors with individuals to observe changes with speed, fatigue, and on inclines/declines, and utilize a series of movement tests to give me more information regarding strength, coordination, and mobility. Below is a list of generic running form cues / suggestions to consider. As with all things generic, what you’re starting from is relative, so not all suggestions are ideal or correct for each individual.

  • “fall forward from ankles” (effective acceleration phase)
  • “Elevate sternum. Chin down. Eyes up.” (spine alignment)
  • “Shoulders relaxed, down, and elbows in” (relaxed arm swing transferring rotational moment)
  • “Drive elbows back” (arm swing)
  • “Swing fingertips past hips” (arm carriage)
  • “Run from the hips” (core awareness)
  • “Lift from your knees” (hip flexion)
  • “Heels to butt” (increase swing speed by reducing lever arm)
  • “Toes to nose” (ankle dorsiflexion)
  • “Fairy-feet” (light, quick steps)

The reality is that concentration on your biomechanics should always be a part of effective training. Running a faster race is dependent upon one’s ability to maintain energy efficient biomechanics under conditions of fatigue. The good thing is that, it’s just like riding a bike! Coordination improves with practice. You only really lose it if you lose the ability to generate sufficient force.