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 (Figure 2). The thigh moving backwards reduces this compression2. 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.
Is there research to back up this theory?
Yes. 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 irritation3,4. 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 to help with my pain?
Most of us suffering from fat pad irritation will benefit from strengthening into hip extension (moving the thigh backwards), external rotation (rotating the thigh to the outside), and abduction (moving the thigh out to the side) strengthening. 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% of patient cases after 7 visits when looking at a database of 106 case studies6
If you are out there and suffering from IT band pain (fat pad irritation), seek out help! Not sure if it’s your IT band? Make an appointment with your local PT for an injury screen. They can find the root of the problem and point you in the right direction.
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
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