IT Band Syndrome: What is it?!
By Dr. Lenae Sexton, PT, OCS
Ah, the elusive IT band syndrome. If you’re reading this, you probably have experienced it in the past or are currently dealing with it. This injury is very painful and is often misunderstood. Most often it is set off by repetitive lower body activities, such as walking, running, hiking, etc. That’s not to say that other activities are excluded, only that these are the most common. Getting a better understanding of this injury can be pivotal in your recovery because once you can wrap your mind around it, you can see that it is most certainly treatable. Read on!
Anatomy Simplified
To truly understand IT band syndrome, we first need to clear up what the IT band (sometimes called “tract”) actually is…
The iliotibial band is a long, dense, fibrous reinforcement of the TFL muscle (tensor fascia latae – one of the hip flexors). It has attachments to several components including areas of the pelvis, hip capsule, tibia (shin bone), patella (knee cap), gluteus maximus, and of course the TFL.
The two big takeaways from all this are:
1. It is VERY dense fibrous tissue.
2. Since it is attached to so many things, it can be pretty vulnerable to imbalances in force.
The Syndrome
Quite simply, IT band syndrome is inflammation of this fibrous tissue due to excessive compressive or tensile (stretching) loads. To simplify further: tugging or pushing on the IT band too hard over and over again in a single direction makes it cranky. This is why it is often set off in repetitive activities; repetitive activities put it under the same load again, and again, and again.
The “Why”
That’s it, cranky tissue. But, of course, that’s not what you’re looking for right? At the end of the day, the “what” doesn’t give you the “why.” The “why” is the best part because it tells you what the heck you can do about it.
Let me start with the mythical “why.” Your IT band is NOT too tight. For one, you want this fibrous tissue to be tight so that it can do its job of providing reinforcement. Beyond that, though, it doesn’t function in the same way that your muscles do in regards to changes in length. Even if it were tight, it is (as far as research shows) impossible to actually stretch it. What all of this means is that the length of your IT band likely has little to no bearing on the imbalance in repetitive force that made it cranky. So, no need to try to stretch it.
The real “why” can be relatively complex as it involves, as I mentioned above, many different influences at the pelvis, hip, and knee. When each of those parts moves in the right rate, timing, and force, the loads on the IT band can disperse evenly. Which means a happy IT band. This means that the gluteus maximus, TFL, quadriceps, gluteus medius, hamstrings, and even the shin/calf muscles must be all firing in concert. When there is a weak or uncoordinated link, the synchronization is interrupted and can result in cumulative strain on the IT band. Figuring out which component(s) of the system are misfiring is the key. While I cannot identify where your “weak link” is without proper assessment, I can provide you with 2 of the more common problems contributing to this injury. Please know that no two bodies are the same, so no two IT band syndromes are the same. There is normally more than one contributing factor.
Common problems contributing to IT band syndrome:
1. Gluteus medius dysfunction leading to pelvic drop (pelvis is unlevel) when on one leg. There are points in time when walking, running, climbing stairs, hiking, etc. when we are one leg. If the gluteus medius is weak or uncoordinated, the pelvis might drop which then causes excessive pulling on the IT band. The extra pulling may occur at the hip end of the IT band or at the knee end of the IT band. So, training the gluteus medius will be critical in this presentation.
2. Gluteus maximus dysfunction leading to knee valgus (knee collapsing inward). This typically happens during single limb phases of motion, but not always. As the knee caves inward, it causes excessive pulling on the IT band. Normally the impact is felt at the knee end of the IT band for this presentation. So, training the gluteus maximus will be important in this case.
Hiring a skilled physical therapist who can assess your movement from top to bottom is ultimately what you need. Even if you have one of the two problems presented above, there may be other contributing issues. If you’ve tried every “quick fix” you could on google without success, it’s time to consult with a PT!