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

“Best Aspects of Being a Physical Therapist”

During a follow up session with an inquisitive high school runner, she asked several poignant questions and made statements that help illustrate the best aspects of being a physical therapist.

The first question was, “Do you know every muscle in the body and what they do.”

I thought for a second and responded, “I think so.” I thought a brief instant more. “Well yes, of course. I probably could be stumped, though, if push came to shove.”

Then I went on to explain that it is more complicated than knowing the muscle and its action (what joint/s it moves), because it really is relative to the body position at an instant in time and whether a foot, both feet, one or both hands are in contact with an immovable object, such as the ground. How one moves during his/her meaningful task is variable, and there may be one strategy to accomplish the task that is painful, but the best part for me as a physical therapist is figuring out how to help someone perform that task without pain.

She then asked, “So can you do physical therapy to yourself.”

I replied in a somewhat disappointed tone because this is commonly how physical therapy is viewed. “No, and here is why…”

I went on to explain that physical therapy is a profession, not something one ‘does.’ As a physical therapist, I have a large toolbox of ‘treatment’ options, and as a professional I have to decide what the best strategy (which tools) to employ in order to address my client/patient’s pain complaint or performance goals. The best part of that is problem solving and having the time to work one-on-one with an individual to address him/her as a unique person. It is a partnership, and someone opening up to allow me to share in a sliver of his/her life experience is extraordinary.

The last statement this young patient made pertained to her preventing pain and injury in the future, so she can continue to live an active lifestyle as she goes off to college and beyond. For me this is really what our profession needs to be about. Physical therapists have the opportunity to be ‘upstreamists’ in the realm of healthcare through educating our patient/clients about healthy movement unique to his/her experience.

This is why I do what I do.

 

-Erik Bies, DPT MS

 

Check out this awesome TED talk about “Upstreamists” in healthcare, and understand how you as a healthcare professional should be thinking, and for those who are clients or patients, what you should look for in your healthcare practitioner.