What to Know About your IT Band

Editor’s Note: Last month, we introduced a new series with a local physical therapist, Dr. Kevin Spahr at PRO Therapy in Minneapolis. In his first article, Dr. Spahr discusses the anatomy of the iliotibial band, a common injury site for runners, and gives an overview on the cause and treatment of IT band syndrome. Dr. Spahr has extensive experience managing injuries related to running and we’re excited to share his knowledge with you!

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Running puts various stresses on the body, which either in an instant, or over the course of time, can lead to problems with the musculoskeletal system of our bodies. The musculoskeletal system consists of our bones, muscles, tendons, ligaments, joints, cartilage and other connective tissue. When this system is negatively affected, you will hear terms such as sprains, strains, tendonitis or arthritis to name a few. The primary function of your musculoskeletal system is, in simplest terms, to provide support, form, stability, and movement to the body. Our IT band is part of this system and is a common problem area to runners of all ages and levels of experience/athleticism. In this article, we will discuss the IT band addressing both preventative and rehabilitative measures to assure your success in reaching your running goals.

Anatomy

In my opinion, it is imperative to provide education on both the anatomy and function of the IT band (or any body region for that matter) to gain a true appreciation and understanding on how to manage any issues that may arise during leisure, training, and/or competition running.

The IT band is composed of fibrous connective tissue that runs down the outside of the thigh. IT means, iliotibial, which is in reference to the anatomical connection sites of the band. The IT band connects up top at the ilium bone of the pelvis, also providing surface attachment to the gluteus maximus (buttock) and the tensor fasciae latae (TFL) muscles. At the bottom, the IT band connects to the tibia bone of the lower leg.  The primary function of the IT band is providing stability for the knee.  Dependent upon the degree of bend in the knee during use of the leg, the IT band will have different levels of laxity or tautness.

Iliotibial band syndrome is a common condition which describes the pain caused by inflammation of the IT band as it crosses the lateral epicondyle (bony projection on the outer surface of a bone) of the femur. When the leg is in a straight position, the band fibers are in front of the epicondyle. As the knee flexes or bends, the fibers move across the lateral epicondyle and are eventually positioned behind or posterior. Problems begin to occur when friction is generated from the IT band coming into contact with body structures on the underside of the band, including but not limited to the lateral epicondyle of the femur bone. Friction over time can lead to inflammation, pain, decline or loss in function, and the inability to participate in tasks we enjoy in life including running.

Risk Factors

• Overuse
• Inadequate warm-up and/or cool down
• Anatomical factors (leg length discrepancy, etc.)
• Muscle strength/flexibility limitations
• Poor shoewear (inadequate support, etc.)
• Poor training habits (terrain, etc.)
• Poor nutrition and/or hydration
• Postural/Mechanical imbalances

Signs/Symptoms

• Pain at outside of knee either above, below and/or at joint line
• Dull, aching and/or burning sensation at outside of knee during or after activity
• Sharp, stabbing pain at outside of knee during or after activity
• Snapping and/or popping sensation at outside of knee during activity/motion
• Swelling isolated to outside of knee
• Referred pain up to hip or down to foot

Pain can be a signal to a runner that a problem exists, and should be addressed.  In many cases, pain can signal an overuse situation.

Treatment

The main goal in managing any IT band issues that may arise is to decrease inflammation/pain, identify any factors that may be contributing to the problem, and as soon as possible get you back to running and enjoying life!  Below is a list of general initial conservative treatment strategies to assist you in your recovery:

• Cryotherapy (Icing) – Icing the painful area at minimum three times per day for 20 minutes to assist in decreasing inflammation. If possible, on/off icing intervals for 20 minutes can also be implemented to more aggressively manage the symptoms dependent on time availability.

• Rest – It might be a good idea to take a little time off from running to help heal the inflamed area (2-4 days). This point is extremely important if no rest is taken and the pain continues to persist with running tasks or even begins to present itself in normal everyday functional tasks like walking, going up/down stairs, getting in/out of chairs, etc.

• Self-Massage or Foam Rolling – Massage via yourself or a foam roller can assist in helping to promote some flexibility within the IT band, which has a tendency to become more taut and restricted with inflammation. However, caution should be taken with this measure as the IT band can become quite sensitive to touch or mechanical force. Pay attention to how your body responds and make sure you aren’t making things worse by being too aggressive with your approach.

• Medication – NSAIDS (non-steroidal anti-inflammatory) medications may also be used in the instance of acute pain at the outside of the knee in conjunction with the other treatment measures noted in this section. Short-term use only is recommended due to potential side effects from these medications. Some common NSAIDS include Advil and Aleve.

If the treatments noted above fail to completely resolve symptoms, or the symptoms worsen, it may be time to see a physical therapist for further evaluation and treatment.  Below is a list of a few treatment measures used in my clinic to assist in recovery from this debilitating condition. Feel free to visit our website at www.protherapymn.com to learn more about PRO Therapy, or contact us directly at 612-767-9917.

• Graston Technique - (Manage restrictions in soft tissue including the muscle & fascia)
• Kinesiotaping - (Promote musculoskeletal support & function of the affected area)
• Spinal/Extremity Manipulation or Mobilization - (Restore normal joint mechanics & muscle activation/inhibition patterning)
• Dry Needling - (Pain relief & restoration of healthy physiology)
• Stretching Exercises - (Address flexibility & range-of-motion limitations)
• Functional Strengthening Exercises - (Address strength deficits & muscle imbalances)
• Modalities - (Decrease inflammation & promote tissue recovery)
• Electrical Stimulation, Ultrasound, Laser therapy

Still unsure if a visit to a physical therapist is necessary? PRO Therapy offers free consultations (612-767-9917) to assist in your decision-making.

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Have other running related injury questions?

If you have other injury related questions, contact us and we’ll pass them along!