IT Band Syndrome

If you are a runner, you have probably heard one of the dreaded iliotibial band syndrome or ITBS.. It seems that there is a lot of confusion, however, on what it is, and what to do about it.
The iliotibial band, or “IT band”, is a long band of connective tissue that runs along the outside of the upper leg. It crosses the outside of the knee and inserts at the very top of the tibia. While many people envision the IT band as a muscle, in reality, it is nothing more than a thickened strip of fascia. Fascia is the connective tissue that encapsulates the muscles of the entire body. The IT band serves as a connection between many of the major hip muscles and the knee. Its main function during running is stabilizing the bottom (supporting) leg during footstrike. Iliotibial band syndrome, or ITBS, is an injury to the IT band. Pain is usually felt on the outside of the knee.
ITBS accounts for somewhere between 8 and 10% of all running injuries,1 and doesn’t seem to discriminate: both recreational runners and elites suffer from this injury. IT band syndrome usually hurts after a set distance into a run—you’ll feel okay for a mile or two, but the outside of your knee will start to ache, progressing from a dull stiffness to a sharp or burning pain. It is typically worse when going down hills, and you may sometimes feel pain when sitting with your leg bent for a long time. Any activity which brings the knee into 20-30 degrees of flexion can aggravate the IT band, as this is when the band itself gets squeezed against the femur the most.
What is the first thing to check? How old are your shoes? Over a year? Get new ones. What else? Check your running surface. If you always run on one side of the road, your body may be attempting to compensate for the pitch on the road (high in the middle, low on the sides). Aside from these issues, it is probably weak hip muscles. I know a lot of runners, and most of them just like to run, and nothing else. Some of them seem to pride themselves on the fact that they do no stretching, no strength training, no cross training. All of these are very important for runners. Recent research has connected hip abductor and external rotator muscle weakness with ITBS. In a healthy and strong runner, these muscle groups keep the hip abducted and the knee externally rotated, which limits the strain on the IT band. But when these muscles are weakened, the hip adducts and the knee internally rotates after impact with the ground, crushing the IT band and the underlying sensitive tissue against the lateral femoral epicondyle. Instead of the gluteus medius and the other main hip abductors firing, the TFL (tensor fascia lata) muscle fires, which puts even more strain on the IT band.

IT band syndrome is a classic biomechanical problem. Muscular weakness and dysfunction causes a predictable and repeatable change in running mechanics, increasing strain on the IT band and causing injury. So, while the painful area is the outside of the knee, the real problem lies further up the leg. While icing, stretching, and foam rolling all have their role, a biomechanical problem ultimately needs a biomechanical solution. This is where hip strengthening exercises come in.

My personal favorite exercise for this issue is a side plank with a little something extra. I have seen many people do side planks in an aerobics class, or on one of these home video programs such as P90x. Most of these lack a movement of the top leg. It is this combination of movement of the top leg along with stabilizing of the bottom leg that is the key to correcting hip biomechanics.

Pictured below is this exercise along with a “cheater” version if this exercise is too difficult. If you can do three sets of 12 on each side, you should have no problems with your IT band.

Dispelling common exercise myths

It's funny how some things just get repeated so often that no one questions it. Such is the case with many exercise "traditions" as I call them, for they are not scientifically tested. It's just always been that way, so it must be true.
The one that I have heard most often lately involves the squat. Almost every person that has had a personal trainer or fitness instructor show them squats has heard the following : "Don't let you knees go over your feet".
I wish I knew how this one started because I believe that the only research study to indicate high knee stress in this position, also indicates high low back stress in the other position. Somehow someone decided to only follow half of what this study concluded.
Basically what happens that is if you restrict your knee movement to the point where they don't go past the feet, then the torque in the hips increases. This means that the butt sticks out more, and they resulting position is more of a bow than a squat. Here is the direct quote from the study published in the Journal of Strength and Conditioning Research :
http://journals.lww.com/nsca-jscr/abstract/2003/11000/effect_of_knee_position_on_hip_and_knee_torques.1.aspx

"Although restricting forward movement of the knees may minimize stress on the knees, it is likely that forces are inappropriately transferred to the hips and low-back region. Thus, appropriate joint loading during this exercise may require the knees to move slightly past the toes."

As a former personal trainer, I am familiar with good form during a squat. I am also familiar with numerous patients with low back pain from this misinformation. What's the take-home message here? Consider your source. Even "professionals" are often misinformed.

Common Exercise Mistake #3: Never Using Full Range of Motion

If you have ever been to a gym, you have probably seen someone doing these exercises:

There is nothing inherently wrong about either of these exercises, but all too often theses exercises are done exclusively. In the first exercise the person does not raise his arms above level. The shoulder joints has one of the largest ranges of motion, yet all too often half of these motions are ignored.

In the common sit-up, the same problem exists in that there is no lumbar extension. The person stops at neutral. People are often afraid of goingg into extension, in fear of low back pain. Yet, if we never us this range of motion during exercise, it is guaranteed that you will become dysfunctional doing any movements in this range. Also, this results in an excessive amount of lumbar flexion, which is unfortunate, as this position is akin to someone slouching.

If you are doing these exercises, and have chronic shoulder pain or low back pain, please contact my office for a consultation at (616) 301-3000.

Most Common Exercise Mistake #2:

Too much abs, not enough low back.


How many ab exercises can you name?
How many low back exercises can you name?
Have you ever seen a program called "the secret to tree-trunk-like low back muscles?"
We tend to focus on what we can see (abs, pecs, biceps).
We also tend to avoid exercising areas where we have had pain in the past, yet this is exactly where we need to to focus most.

New Years Resolution Exercise Mistakes

As a former personal trainer, it became apparent to me how unprepared I was in handling client's injuries. Resurfacing back pain, rotator cuff danage or knee ligament tears would constantly create unwanted setbacks. My training and experience as a Chiropractor has now allowed me some insights into common training mistakes. As you are now hopefully making strides to incorporate more physical activity into your life as part of a new year's resolution, please use common sense and heed some advice from someone who has helped many people through these common exercise pitfalls.

Common mistake #1: poor posture during exercise. If you cannot maintain good posture while exercising, there is no chance you will be able to maintain it during everyday activities. Excessive forward head posture is by far the most common.