What is IT Band Syndrome & What Causes it?
IT band syndrome is a common lower extremity complaint that presents as pain that is located on the outside aspect of your knee. Other sources of lateral knee pain can be a LCL sprain or lateral meniscus tear.
The pain is due to the friction of the IT band rubbing against the lateral femoral condyle of your femur as the knee flexes and extends. Normally, these biomechanics do not cause knee pain. It becomes symptomatic when the IT Band has increased tension (aka tightness) due to dysfunctions above and below of the knee joint.
When the knee is neutral, the IT band is anterior (in front of) of the lateral femoral condyle. However, as you flex your knee to 30 degrees and beyond, the IT band shifts posterior (backwards) to this bony prominence. This shifting of the IT Band is what causes the friction and ultimately leading to the pain & inflammation. 1
This diagram that I drew below displays the relationship of the IT Band with knee flexion (bringing your heel to your butt). Please don’t laugh, it was drawn by a chiropractor.
Do not look at the location of pain to find a solution
Tight Hips Can Cause IT Band Syndrome
As a chiropractor, it is important to view the joints above and below of injury. The same holds true with IT Band Syndrome. The tensor fascia lata (TFL) and 1/3 of the gluteus maximus both attach to the IT Band. When these muscles become tight or restricted, their is an increase in amount of tension/tightness of the IT band due to their common insertion.2
Below are short example stretches and foam rolling techniques to address a tight gluteus maximus and TFL.
Weak Hips Can Cause IT Band Syndrome
Another cause of IT band syndrome can be glute medius weakness. The gluteus medius and TFL both function as abductors of the hip. Hip Abduction is the action of bringing your leg away from midline.
The hip abductors also function to keep the pelvis level and prevent our pelvis from shifting to side when walking. Trendelenburg Gait is dysfunctional gait pattern when the hip abudctors fail to carry out this job.
Since the tensor fascia lata and gluteus medius both share the function as hip abudctors – if one muscle is underperforming, it will increase the work load for another. This increase in workload can lead to tightness. When the gluteus medius is weak in comparison to the TFL, it increases the tension of the IT Band and can leads to IT band syndrome. In order to decrease this imbalance of strength, it is important to perform a gluteus medius strengthening exercise that limits TFL activaiton.
Bob and Brad, the self proclaimed worlds best physical therapists on the internet, demonstrate below how to target the gluteus medius. The offer a variety of exercises depending on your level of strength.
Over-pronated feet can cause IT Band Syndrome
Flat feet (aka pronation) can lead to internal rotation of the tibia and thus increases the tension of the IT Band.4 There are many causes of over-pronation and I highly suggest you seek out a professional, such as a chiropractor or physical therapist, to determine which treatment is best for you.
Examples of treament for overpronation:
- short feet exercises
- orthotics
- correcting leg length discrepancies
- ankle mobilizations to restore proper biomechanics
- Strengthen the tibialis anterior
- Manual therapy and stretching to the peroneals
Conclusion
Regardless of the injury, it is crucial to correct the dysfunction above or below the joint. Do not chase the location of pain when seeking a solution. Seek to see the big picture and you will be more successful with your own self rehabilitation of IT band syndrome and many other common injuries.
References
- Vizniak, N., 2020. Evidence Informed Orthopedic Conditions. Professional Health Systems Inc., pp.252
- Kisner, C., & Colby, L. A., 2012. Therapeutic exercise: Foundations and techniques (7th ed.). F.A. Davis., pp. 720
- Sahrmann, SA: Diagnosis and Treatment of Movement Impairment Syndromes. St Loouis: CV Mosby, 2002.
- Vizniak, N., 2020. Evidence Informed Orthopedic Conditions. Professional Health Systems Inc., pp.252
Dr. Brandon Parnham, DC 