Thursday, February 6, 2014

IT Band Syndrome

Possibly one of the most frustrating chronic injuries in athletes it iliotibial band friction syndrome.  The unrelenting lateral knee pain that no matter what you do will not go away unless considerable time is taken off from training.  Time off from this injury can range from a couple weeks to several months. "The Surprising Iliotibial Band" looks at the anatomy of the IT band and challenges the long thought idea that the band flips over the lateral part of your knee and thus causes you pain.  As it turns out, they found that the IT band does not move front to back across the outside of your knee (femoral condyle) but in a inward and outward motion that occurs when the knee is flexed and extended (see picture).  Along with this the authors found that the band actually wraps around the lateral quad and attaches deep to the femur showing the immense connection is has to the lateral side of the leg and why it causes so many issues and pain.

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This information is good but what does it all mean for those in pain?  A common form of recommended treatment is to "role out" and stretch the IT band.  The problem with this is that the IT band is like a steel cable and can only elongate about 0.2% of its original length.  What this suggests is that to help relieve strain on the most superficial part of the band its attachments at the glute max and tensor fascia latae (TFL) must be lengthened to help down the kinetic chain.  Focusing soft tissue work, stretching and strengthening in these areas can help reduce symptoms that occur at the knee.  Soft tissue work of the entire lateral quad can also help relieve pain and symptoms further down the kinetic chain.  Caution must be exercised here as well.  You want to avoid the area of the IT band as it approaches the lateral knee.  Pressure and work her can aggravate already inflamed tissue and add to your current problem.  Work only the muscle belly of the lateral quad from distal to proximal.  One technique we have found useful for pain at the lateral knee is myofascial decompression (cup therapy) in that you are mobilizing tissue but also drawing adhesions/scarring away from the areas of irritation.

A frustrating injury none the less and prevention is key but strengthening hip abductors and keep the glute max and TFL moving freely in order to keep biomechanics in line.  Contact us with any further questions.

The Surprising Iliotibial Band
J Amer Chiropr Assoc 2011 Sept-Oct; 48(7): 2-6

Dr. Thomas Michaud