by Nora Gilman, MS, LAT, ATC
IT Band (ITB) syndrome, otherwise known as Runner's Knee or Snapping Hip Syndrome, is tightness of the iliotibial band - and it plagues plenty of athletes at some point in their athletic careers. Runners make up the largest percentage of athletes suffering from ITB syndrome. The onset of symptoms are easy to spot. Usual symptoms are pain over the hip bone during hip flexion or over the lateral knee during 30 degrees of knee flexion as the ITB rubs over the lateral epicondyle of the femur. This chronic injury is hard to treat, but it is treatable. Here are some 'Dos' and 'Donts' for how to address IT Band syndrome. TIP: Understand that if you are a runner, the best way to treat ITB syndrome is to prevent it from happening in the first place. Treatment strategies for the syndrome can be used as preventative strategies as well.
DON'T: FOAM ROLL THE IT BAND
I'm not sure what the fascination is with foam rolling the ITB. The method is prescribed by dozens of practitioners, but did you know that it takes a force of approximately 1,000 lbs per square inch to change the ITB? Because of its thickness and resilience, applying large, sweeping foam rolling movements up and down the ITB is an ineffective strategy to make any change in the tight tissue. Foam rolling the lateral leg is at best, only reaching the lateral quad and hamstring which surrounds the ITB.
DO: SMALL, CIRCULAR, LIGHT RELEASE
There is scientific evidence that fascia (tissue type of the ITB) reacts better to light release methods. Hard or forceful release methods such placing your full body weight on a foam roller causes the fascia to become more agitated. My advice is to track up and down your ITB with fingertips to find the most tender spots and use a tennis ball to apply a small, circular, light release in those places.
DON'T: THINK THAT JUST RELEASING THE ITB WILL FIX THE PROBLEM
The ITB attaches to and extends from a hip muscle called the tensor fascia lata (TFL), but for some reason, the two separate tissues are addressed as if they are one component. The TFL is a hip internal rotator, an abductor, and a 'weak' hip flexor. The TFL commonly becomes dysfunctional first, before the ITB issues set in. Most often, athletes that only run (marathon, cross-country, ultra-marathon), have a weak TFL because they rarely perform lateral activity (side-to-side), which are movements that would generally strengthen the TFL. In the human body, if one muscle is insufficient in performing its job, other muscles will take over and cause tightness and pain. But, the ITB isn't a muscle? Correct, but anything in the body that has proprioception (a subconscious sense of perception, or nerve input) can compensate for inhibited muscles. Going back to the title of this classic mistake, you must understand why it’s tight instead of just treating the symptoms with release.
DO: RELEASE AND STRENGTHEN
In the example I gave above, a runner that only releases the ITB is neglecting the root cause-- a weak TFL. Coupling release and strengthening the weaker, less-active muscles (like the TFL) is the best way to get the ITB to stop working so hard. This will result in a full release and a decrease in pain or the snapping sensation. In athletes, this is easier said than done. I find it is very hard to balance out compensation patterns in athletes because jumping back into their activity (running, for instance) causes these faulty movement patterns to simply be reinforced once again. Constant repetition of releasing and strengthening the correct structures is key. This leads me to my next point: when I suggest to an athlete that their TFL could be the cause of their symptoms and tell them how to strengthen it, they explain to me that they do that every day in practice. Performing lateral band walks, without a release first, means the athlete is more than likely STILL using the IT band to complete the movement. Or more often, the athlete is not performing the band walks correctly. A solution to both problems is to make the exercise more simple.
DON'T: TAKE ADVICE TO COMPLETELY REST THE INVOLVED LEG/KNEE TO FIX IT
I'm not in favor of resting the athlete to ‘fix’ ITB syndrome. As you learned from above, rest does not help strengthen muscles that need to be strengthened, and rest does not release the fascia. Complete rest will certainly make any injury feel better, but the pain is likely to come back upon resuming activity.
DO: MAKE ATTEMPTS TO FIX THE PROBLEM IF YOU HAVE TO REST
If there is enough pain that you need to discontinue activity, couple rest with proper corrective exercises and cross-training. This will make sure the pathology does not instantly come back when returning to activity. Additionally, cross-training or engaging in activities that do not exacerbate symptoms while keeping up your aerobic fitness (such as cycling) can help maintain your conditioning levels.
Final Points: While most cases are like the example above, each athlete is different and dysfunction can manifest differently amongst individuals. I advise being properly evaluated to find the issue specific to you. We know ITB syndrome is common in athletes that lack side-to-side movements and we know the causes; therefore, to avoid set-backs in the future, vary your activity to incorporate lateral movements and perform proper corrective strategies.