What is IT band pain and what to do about it.
Have you ever been running or hiking and the outside of your knee starts to hurt? Well, you may be suffering from pain coming from your IT band. IT band pain is common and accounts for up to an estimated 22% of all lower extremity injuries1. It’s the pain along the outside of the knee that usually kicks in around a mile or two and then just becomes relentless. It makes those long runs or hikes literally impossible.
What is the IT band?
The IT band, or iliotibial band, is an extension of your hip muscles that runs along the outside of your thigh and connects down into the knee. The purpose of this band is to stabilize the outer part of the knee.
What causes IT band pain?
The traditional theory stated that excessive friction at the knee caused IT band pain. Specifically, this friction happened where the band rubs over the bony prominence (Lateral Femoral Condyle). Excessive tightness in the band causes a friction syndrome that causes pain. However, this theory has a problem: treatment meant to lengthen this band has mostly not succeeded.
Here’s a second theory. The pain isn’t from the IT band itself, but a small fat pad underneath the IT band near the knee. Research has determined that in cadavers the IT band actually doesn’t roll over the Lateral Femoral Condyle. However, the fat pad underneath the IT band becomes compressed when the thigh rotates in towards the midline. The thigh moving backwards reduces this compression.2 This second theory appears to be accurate. I have seen good success in reducing patients’ pain when treatments correct movement patterns instead of only trying to lengthen the IT band.
What does research say about IT band pain?
Recent research has shown that excessive internal rotation of the thigh (thigh rotating in) as well as adduction (thigh moving inwards) is associated with fat pad irritation.3,4 Furthermore, it has been shown that the muscles that prevent the knee from moving in these directions are weak when there is a fat pad irritation5.
What can I do for IT band pain?
Most of us suffering from fat pad irritation will benefit from strengthening exercises, such as hip extension, external rotation and abduction. The gluteal muscles are the prime movers and should be the first targeted treatment area to fix this problem and ensure a more normal movement pattern.
Other treatments that can help include addressing abnormal movements at the foot and ankle, modification of running or provoking activity, altering running form, taping for very painful cases, and soft tissue treatments to promote changes in the surrounding tissue that may be contributing to symptoms.
Current outcomes actually suggest that a soft tissue treatment called ASTYM improves symptoms in 98.1 percent of patient cases after seven visits when looking at a database of 106 case studies.6
Physical therapy can help you move pain-free
Whether you’re a seasoned runner, a weekend hiker, or someone simply trying to stay active, IT band pain can be frustrating and limiting. Fortunately, you don’t have to push through the discomfort or stop doing what you love. At Therapeutic Associates, our physical therapists are movement experts who can identify the root cause of your pain and develop a personalized treatment plan to restore strength, mobility, and balance.
Through a combination of hands-on care, targeted exercises, and education, we’ll help you reduce inflammation, improve biomechanics, and prevent future flare-ups. If IT band syndrome is interfering with your active lifestyle, reach out to a clinic near you — our team is here to help you move better, feel better, and get back to doing what you love.
References
- Linenger JMCC. Is iliotibial band syndrome overlooked? Phys Sports Med. 1992;20:98–108.
- Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of Anatomy. 2006;208(3):309-316. doi:10.1111/j.1469-7580.2006.00531.x.
- Noehren B Davis I Hamill J. ASB clinical biomechanics award winner 2006: Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech. 2007;22(9):951-956.
- Noehren B, Schmitz A, Hempel R, Westlake C, Blake W. Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. J Orthop Sports Phys Therapy. 2014;44:217–222. doi: 10.2519/jospt.2014.4991
- Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 10: 169–175, 2000.
- ASTYM outcomes database. https://astym.com/Content/documents/Astym%20Therapy%20All-Inclusive%20Diagnoses%20Outcome%20Reports%207-6-2016.pdf
Are you experiencing discomfort with running or other activities?
Our physical therapists can help you return to a pain-free, active life. Our passion is to help every patient reach their goals on their journey to recovery and optimal performance.
