Iliotibial band syndrome is the probably the second most common knee related pain which affects runners. IT Band pain is also a common injury for cyclists. The most common complaint is outside knee pain which can be from mild to excruciating. People often complain of soreness, burning, shooting and sharp pains. Can also have thickening and swelling of the band. IT Band pain often presents with patellofemoral pain syndrome.
Hey guys, this is Manu Kalia, physical therapist and Ayurveda herbalist. So this is my next video on some of the knee-related problems a lot of you guys have been asking me about. And before I get into it, I want to remind you that we have our program coming up and it’s going to be launching very soon. So if you’re interested, get onto the site and make sure you sign up so you’re one of the first to hear about it. And as I mentioned I’ll be giving out some free copies, and the program is on knee injuries and how to get better, how to rehab, so combine both the holistic as well as the physical therapy and exercise science components together. It’s going to be a pretty awesome program. We’re very excited. We’re on the final phase. We’re getting the program done.
So the problem that I’m going to talk about today is IT band issues. So I’ve tried a bunch of videos in the past and I’ve discussed some of the treatment methods. I’m going to give you a little bit more in terms of the anatomy and what are some of the contributing factors to the problem.
So let’s just look at the knee model here and let’s kind of get a sense of what’s happening. So this is the front of the knee, this is the side view, your femur is the thigh bone on top, tibia is the shinbone at the bottom, and then you have your fibula – it’s that small bone that sits on the outside of your lower leg. So IT band issues or iliotibial band problems are very common in runners and cyclists, but again it can affect anybody, any athletes or even people in the sedentary population get affected by this problem, but definitely much more common, probably the second most common knee-related issue for runners, I would say.
The first one is the patellofemoral pain or runner’s knee or anterior knee pain that I discussed in my last video. This is probably the second most I would say common issue. And often, the patellofemoral pain, which is the kneecap and surrounding tissues causing the problem, and the IT band issues come together often or they definitely can come together.
Okay, so the IT band is that thick band that goes along the outside of your thigh. It’s that thick band that’s going on the outside of my thigh. It’s coming below that knee and attaching down on your tibia, on the upper part of your tibia, which is your shinbone right here. But you have fibers also of the IT band coming and attaching on the outside of your kneecap too and the IT band, it’s a thick connective tissue, so facial tissue, which attaches even on the bone itself, the thigh, going deeper and attaching. So it has few attachment points, and of course further up in the chain it’s attaching at your pelvis as well as some of the local muscles through here too.
So attachment site is here, it’s coming on the outside of your thigh, and the most common area of pain referral is going to be outside knee pain, so generally a person will point to pain on the outside of the knee, and most often the lower part of the IT band. You can have some stuff further up by the hip, too, on the outside of the hip or along the chain, but majority of the time the problem is indicated as pain is right here on the outside. So, can have a lot of tenderness along that region, can have some swelling, can have irritation, can be very sensitive to touch, burning sensation – so sharp pain/shooting pains. So all these things can be caused.
Now, underneath the IT band you also have fat which is highly innervated, so a lot of compression and irritation of that fat tissue. The bursa is basically a fluid-filled sac that sits underneath the IT band as well as the bone to prevent the band from rubbing into the bone. But some of the studies show that it’s not a bursa, so it is a little bit inconclusive. But nevertheless, all those structures, the IT band itself, and all the surrounding tissues, the highly innervated fat underneath it, all these structures can, if there’s repetitive rubbing and irritation of that tissue, can cause pain. Not only will it refer pain here but it can sometimes radiate in the outside of the upper part of the lower leg, too. It primary affects the outside knee, but then some of the fibers are attaching on the outside of that kneecap, so lateral patella pain is also not uncommon. So very often when you start digging in, you start checking the kneecap, the person can be very tender along that border, too, in addition to that band that’s running on the side.
What are the contributing factors? Overtraining is one of the big ones. Repetitive strain or overtraining can cause irritation of the tissue. And why is that happening? One, because you’re doing more than your body or that tissue can handle. Second, due to mechanical factors such as alignment of the kneecap, it might have to do with hip tightness, hip weakness resulting in change in alignment of tissues, excessive pronation or flatfeet. So by itself, one of these things is not the contributing factor, but when you combine all of them together they can definitely throw the biomechanics off, the alignment off, which can cause more stress and strain on that tissue, and of course it can get very tight after a while too and thickened.
So you have to consider that there are a lot of these factors that are affecting this problem. You might be missing an ankle range of motion. You might be missing your big toe range of motion, so your foot, you can’t bring your body over that foot let’s say when you’re walking or running. So you change the alignment of that foot, the foot drifts up; you have flatfeet for that matter. You might be changing your alignment because of that. You change the alignment of the knee. You get knee valgus or the knee drifts medially or the knee is drifting inwards, which is again changing the alignment of that knee in relation to the thigh and even relation to the pelvis or, for that matter, down to the foot. And further up in the chain, you might have stiffness at that hip. Maybe your hip flexors are too tight, your glutes are too weak—your gluteus medius, gluteus maximus—so they’re not stabilizing the pelvis when you’re walking and running, and after a while you get fatigued and then they’re not stabilizing the pelvis in walking and running or any of those activities, and that again starts to change the alignment of the thigh in relation to the pelvis, in relation to the knee. And for that matter, anatomical differences, so wider hips, Q-angle for women – larger Q-angle, have been cited as some other contributing factors. So as I said, not one thing by itself but multiple things combined will often result in an unfavorable environment where there’s excessive irritation of the tissues, which will set up a process where you’re overstraining or overworking that region and that can set up an inflammatory process, constant irritation, sensitivity, so that then after a while even a little bit of activity sets the thing off.
So treatment has to address all those mechanical things, and then of course, remember, treat always above and below the chain to address the problem. This gets irritated because there’s something going on along the biomechanical chain. So address those issues. Then of course, locally also, manual stuff, hands-on techniques, soft tissue mobilization, stretching all those tissues on the outside of that thigh, getting better alignment of that kneecap. Maybe all these tissues have gotten so tightened up constantly being pulled to the outside, so now you have a patellofemoral problem that’s being set up too. So address those issues. So all these things have to be accounted for and addressed. Taping and correcting the foot mechanics, strengthening exercise and flexibility exercise, all these need to be done to get rid of that problem. So all these things need to be addressed. Correcting biomechanics up and down the chain as well as treating things locally by massage or manual therapy techniques or joint mobilization, taping, and then internally taking herbal formulas are different things that can be done to address the problem effectively.
So I hope that gives you a sense of what’s really going on and what’s happening with this issue and why it becomes such a chronic problem for a lot of people and they have a really difficult time getting this under control. But it can be, you can treat it very effectively once you correct all these imbalances, and this is what I am discussing in my program.
Alright guys, please share the video if you found this information helpful. Thank you.