Tackling IT Band Syndrome Head On

So what are we working with?
Illiotibial Band Syndrome (ITBS) is the second most common cause of knee pain in runners. Runners aren’t the only ones who experience this pain it’s commonly seen in cyclists, soccer players, and military personnel. The IT band runs longitudinally along the lateral aspect of the thigh and originates at the iliac crest (hip/pelvis) and down to the proximal tibia (lower leg). The IT Band has broad attachments to numerous parts of the lateral knee and spreads out like a set of fingers reaching into your hip/glutes. These attachments points when inflamed can cause pain in the hip and knee. These attachment points are why ITBS can be hard to nail down the root cause because a weakness in the hips can show up in the knees. Let’s take a closer look at why this can happen and look through some solutions.

Load vs. Capacity

At the root of nearly every injury is the competing priorities of what kind of load a joint or tissue can manage and the capacity of how much it can manage over time. You might be able to hold mid-stance with even hips for 20 landings off a small box but what about 22,000? In the free guide below, Dr. Jesse describes how pain is a product of an imbalance between load and capacity.

LOAD (how much stress or strain we apply to an area of the body or the body as a whole) exceeds the CAPACITY (how much stress or strain that area in question can tolerate in a given time)

This is exactly what happens with IT Band Syndrome - whether you’ve bumped up your mileage or just getting into the sport your body may not have the capacity to manage this new mileage load. A slow methodical build up is key. Understand that no one method or solution is correct however, how we approach your injury and biomechanics does have a well defined path to success. Developing a strong posterior chain is absolutely KEY to building great lower body mechanics that can withstand 26.2, 50, or 100+ miles.

What’s happening at the Hip?

Poor lateral stability (hip drop) is a major cause of hip pain and IT band pain. When your opposite hip drops during midstance phase you are putting the IT band of the midstance hip in tension. This looks like hips dropping below the horizon, knees collapsing inward and from straight on one knee drops below the other. You can imagine that tension can cause some inflammation over a couple thousand steps of your average run - no wonder we have pain right?

This is most often caused by a lower than normal activation of the Glute Medius. Don’t listen to anyone that says your glutes “aren’t firing” if your glutes weren’t firing…you couldn’t get out of your desk chair. Your Glute Medius creates lateral stability around the hip and it’s ultimately what allows us to maintain a level pelvis. Targeting the glute medius with activation, mobilization, and drills will help you maintain a level pelvis over 22,000+ steps of your next marathon. Dr. Jesse and Coach Andrew Simmons created a video to help you activate your hips. This is a great place to start when it comes to finding your weak points and firing up your system!

HIP STRENGTH FOR RUNNERS

What’s happening at the Knee?

Think about cracking a whip, what you do at the handle translates down the whip - think of the posterior chain like a whip. Any disfunction at the hip will ultimately be transferred down the line. When we land mid stance without good lateral knee stability the knee can move laterally because of a weakness in your hips OR from poor biomechanics lower further down the kinetic chain. It’s important to understand how the hip and knee are related when it comes to IT band pain - by what is defined as your quadriceps angle or Q-angle. Given that most women grow wider set hips - the relationship between the knees and hips can lead to IT band syndrome having a higher incidence in women than in men. A high Q-angle is often seen as Valgus (knock knees) vs. Varus (bow legged) - as you can imagine the more lateral part of the knee is stressed in the Valgus position. This is why the IT band can often refer pain to the knee - it’s takin stress from a weak glute medius and a secondary stress from valgus knees - these compounding factors can be tough to solve.

Solving the problem

First we have to take a few tests to be sure

Dr. Jesse Riley has built out an Essential Guide to IT Band Pain and Runner’s Knee that breaks down 4 different tests you can do to help define your greatest places of weakness. Using these tests will help you be more targeted in your approach to removing pain and getting back to putting in miles. However, be conscious that none of the work we’re sharing here will solve your problem in one session. You will need to integrate strength training, mobility, and skill training into your training regimen to reach your full potential as an athlete.

Tests

Single Leg Calf Raise – tests foot/ankle capacity and where you initiate load from bottom up
Single Leg Glute Bridge Hold – tests sagittal capacity at the hip between right vs left
Lateral Step Down – tests lower extremity in many planes during initial contact of running
Side Plank Hip Abduction – tests frontal capacity at hip between right vs left