• Jon Duellman PT

IT Band Pain and "Tightness"

Updated: Jun 26, 2020

Today, we're talking about the "IT Band" and what you should know. We clarify what it is and what you can do about it. At the end, I want to expose some misinformation common online.


Pain on the outside of the knee is not uncommon to athletes and active adults. One area that can be related to this pain is the Iliotibial Band or IT Band. The IT band is a long and fibrous piece of fascia (connective tissue). It connects from the top of the pelvis and runs down to the knee. Our main glute muscle (gluteus maximus) and TFL (tensor fasciae latae) attach to this structure. It helps translate force and stabilize the lower extremity.


IT Band Syndrome


With repetitive activity and overuse, this area can become sensitive and sore. This is labeled IT Band Syndrome. This is a common injury in running and cycling, however it is seen in other recreational activities. The initial theory of IT Band Syndrome is that repetitive activity or motions in which the IT band compresses at the outside knee causes pain to occur. This theory has not really been well supported in the research. What we understand now is that if we aren't used to the activity, the compression to the fat pad behind the IT band can become irritated


So what causes IT Band issues?


In the past 20 years, we have been trying to find the key factor which causes IT band pain. We have looked at biomechanics which seem to have a relevant relationship but does not consistently cause the pain. For instance, we have a small amount of research stating that hip weakness, overpronation (foot and ankle mechanics), and abnormal running gait may contribute. The most consistent relationship we find is increasing training volume of whatever activity the patient has been participating in. Most commonly this is running. It can also be from basic activities such as walking, stairs, or other activities that we may not be used to. For example, an older adult that had to suddenly perform extra stairs frequently on a vacation may develop an IT band issue. This is more rare but possible.


Side Opinion: As we go on a long run, our legs begin to fatigue causing a change in gait mechanics. While the first half of the run may look good, the second half could be related to IT band issues. When we force an increase in time or distance, we may run into the poor mechanics phase of running. A good training program gradually builds to make sure the muscles take the majority of the stress so that other areas such as the IT band are not taking on too much.


What is the Best Treatment?


The best treatment for IT band issues is to have a health professional take a look at your individual circumstance. For some cases, shoes may be important. For another, the client may need to work on running mechanics. A lower extremity strengthening program should be implemented with emphasis on hip strength and endurance in particular. For everyone, the training load must be modified. This doesn't mean stopping but an appropriate deloading in volume or intensity is best.


Misinformation and Myths


To tell you the truth, there is a lot of misinformation out there. A lot of well accepted medical opinions in the past have not been found true in the research. In fact, I wanted to add a video from youtube but couldn't find one that didn't have something incorrect in it.


"YOUR IT BAND IS TIGHT!"

This is the big one. Let me enlighten the world. The IT band is always tight. The job of the IT band is to be tight to stabilize and transmit force from the hip muscles. However, it isn't a muscle. This being said, it can feel tight. You will hear this again from me...

The sensation and perception of tightness does not mean there is a lack of flexibility.

While stretching and massage make this feel better, it is not the cure. The "cure" is the change in training, mechanics, or new strength that improves the condition and prevents a return of your pain.


I'd love to hear your experience with IT band issues and what helped you. Let me know in the comments below or message me.


UPDATE:

A recent podcast from the British Journal of Sports Medicine (BJSM) discusses just this issue with Dr. Rich Willy, an expert on iliotibial band pain. I highly recommend a listen. *LINK*


Reference: van der Worp, M. P., van der Horst, N., de Wijer, A., Backx, F. J. G., & Nijhuis-van der Sanden, M. W. G. (2012). Iliotibial Band Syndrome in Runners. Sports Medicine, 42(11), 969–992. https://doi.org/10.2165/11635400-000000000-00000

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