Iliotibial Band Syndrome

IT Band Syndrome

What is the IT Band?

The iliotibial (IT) band is fascial tissue that runs from your gluteals to your knee on the outside of your leg.  When thinking about muscles and fascia, think about a sliced orange.  As you slice an orange, the “orange” itself is the muscle and the white part is the “fascia.”  Fascia serves to compartmentalize muscles and organs.  It is highly vascularized and innervated, which is why it can cause so much pain.  You have miles of fascia in your body, but the IT band gets the most “press” because of it being a culprit in running injuries.  However, the IT band itself is rarely to blame.

Causes of IT Band Syndrome

The IT Band typically gets irritated on the outside (lateral) aspect of the knee from rubbing over it as the knee bends and straightens repeatedly during running.  There are several potential causes for it.  Overuse, poor shoes, improper training surfaces, and failing to change your running route are all potential “extrinsic” sources.  Runners should avoid running on concrete as much as possible and instead run on black top, trails, or a track.  In addition, runners should never run the same direction or on the same side of the road.  Most roads are “pitched” in the middle and lower on the edges to allow water to run off.  If you run the same direction all the time, the tissues will be stressed in the same way.  Therefore, it’s important to not only change direction on the tracks and trails, but also on the road.  While these are more extrinsic factors that cause iliotibial band syndrome, the more intrinsic ones are typically due to weakness in the gluteals, the gluteus maximus and gluteus medius.  Other intrinsic causes include a wider pelvis, overpronation (pes planus), or high arches (pes cavus).  Flexibility deficits in the hamstrings, hip flexors, and quadriceps can also lead to iliotibial band syndrome.

IT Syndrome Treatment

Truthfully, the focus of treatment should be on exercises to strengthen the gluteus medius, minimus, and maximus.  Core stability exercises should also be an integral part of a strengthening program as they serve to stabilize the pelvis along with the gluteals.  A sports physical therapist should also work diligently on soft tissue techniques to “roll out” the IT band.  This can be done with a foam roller too, but keep in mind, the skilled hands of a physical therapist will pick up specific problem areas better.  Additionally, if you tend to “overpronate,” orthotics could help with this.  That said, “overpronation” is an overused term that really is poorly defined.  We suggest you use caution before spending lots of money on shoes or expensive orthotics until you’ve been evaluated by a physical therapist.  In truth, studies have shown that over-the-counter orthotics are often just as effective as the expensive ones, so start there.  If you have high arches, proper footwear, orthotics, and manual therapy techniques from a physical therapist will help increase shock absorption.  For pain relief, ice massage is a fantastic way to reduce pain after running.  In cases of point tenderness and inflammation, anti-inflammatory medications can help.  Regarding stretching of the IT band itself, this is the topic of much debate.   That said, the sports physical therapists at SSOR believe it’s more effective to “mobilize”/”roll out” the IT band than to stretch it because it usually gets irritated from over-stretching anyway due to weak hips or poor foot control.  We have much better success doing soft tissue treatment on this as opposed to stretching.
If you are struggling with iliotibial band syndrome, or even if you’ve had unsuccessful therapy before, we’re certain our approach will provide you results quickly and a fresh perspective.  Whether you are active or not, this can be an annoying injury.  It would be a privilege to serve you and partner with you in your care.  Give us a call at (913) 904-1128 and our team of skilled physical therapists at SSOR will help you achieve the outcome you desire.