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Iliotibial Band Syndrome

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What’s an IT Band?

You have an iliotibial, or IT band that runs down the outside of each of your legs. This unique ligament serves to move your legs (extending, abducting, and rotating your hip), and runs from your hip to just below your knee. It connects to many of the muscles in your upper legs, including the quadriceps (front thigh), glutei (booty), and hamstrings (back of thigh). It’s also connected to the fascia of your upper leg, which is the tough “gristle” that holds all of your muscles in place.

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Because of it’s location, the IT band is easy to injury with repetitive movement. Running, biking, and even long walks can irritate it if the exerciser’s form is incorrect, putting undue pressure on the bursa sack, which enflames the small pouch. This causes the ITB to meet resistance while moving over the femur, instead of gliding.

Do I Have IT Band Friction Syndrome?

If you’re having lateral knee pain, you may have ITBFS/ITBS.

Signs and symptoms:

  1. Pain on the lateral (outside) side of the upper leg and knee joint.
  2. Snapping or popping sensations around the knee.
  3. Swelling around the lower thigh and knee.
  4. In advanced cases, a radiating pain from the knee up to the hip.

If you think you have ITBS, it’s best to see your physician. Because of how the brain discriminates various areas of the knee, pain can seem to come from an area that is close by, but isn’t exactly where the injury is. A doctor will be able to better judge the cause of the irritation.

If for some reason cannot see a physician, a self test you can perform is:

  1. Sit with legs bent.
  2. With your fingers, press on the outside of the knee in question, just over where you can feel the bone of your kneecap. When you move your knee, you should be able to feel the tendon gliding along.
  3. While putting pressure over the tendon, straighten your leg. Once your leg is at twenty to thirty degrees, your ITB will pass over the bone–if you have ITBFS you will have a sharp pain as it does so.

However, this test is not fool proof. The iliotibial band runs the entire length of your leg, which means that irritation may be at the hip as well as the knee. Further, your thigh is one of the most complicated parts of your body, and the pain may be caused by another malady. The proper procedure with any pain is to rest it. Stretching can be performed as long as it does not worsen the pain. If you feel that you may have a stress fracture or more severe injury, please consult a physician.

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Causes of IT Band Syndrome

ITBS is caused when, essentially, an exercise that mimics the squatting position is performed in a way that lengthens the IT band. This can be caused by improper form, anatomical variances, muscle and flexibility imbalances, or a combination of all.

Anatomical variances, especially leg length discrepancies, can cause one leg to develop a tight IT band as it must slope inward slightly to allow the shorter leg to land.

Runners typically develop the syndrome when they run on the same side of the same road repeatedly during training. Most roads have a slight angle to them, either banked or canted, to channel water–this can cause the legs to overcompensate and has the same effect as leg length discrepancies, since the pelvis is continuously tilted.

Excessive hill running can also be a cause of ITBS, especially if an intense regimen is started without build up.

Bicyclists often develop ITBS as a result of either pedaling with bowed legs, or with a “toe in” form. Both of these variances can cause the IT band to become irritated–it’s best to bike with knees parallel to the center bar and each other.

How to Treat ITBFS/ITBS

Prevention:

Strengthening the muscles of the leg and hips will allow better stabilization of the limb, which will fend off ITBS, as well as other injuries. Even if you prefer a certain kind of sport, especially running and bicycling, make sure that you cross train at least 20% of your workouts.

A thorough stretching regimen, including both active and static stretches, will prevent many injuries. However, if you currently do not stretch, make sure to add various movements slowly, and never stretch to the point of pain.

Treatment:

If you have ITBS, or suspect you do, the first course of action is that of inaction–rest!

Your ligament is enflamed, which puts your knee at risk. Generally speaking, this is a matter of form, as mentioned earlier. Do not repeat the offending exercise for 1-6 weeks, or until you can climb stairs without experiencing pain. During this time, make sure to stretch the injured limb gently, progressing as it heals. If you can manage to get a sports massage, do.

Some common stretches and exercises for ITBS (from RunnersWorld.com):

Stretch #1: Pull foot up to back of buttocks. Cross the uninjured leg over the injured leg and push down, hold for 30 seconds.
Stretch #2: Cross injured leg behind and lean towards the uninjured side. This stretch is best performed with arms over the head, creating a “bow” from ankle to hand on the injured side (unlike how it is depicted).
Stretch # 3: Cross injured leg over the uninjured side and pull the leg as close to your chest as possible.

Foam Roller
Roll your injured leg over the foam roller, add more time gradually each day to help mobilize your tissues and break up scar tissue.

 

Single Leg Balance and Strengthening
May start just balancing on one foot when brushing your teeth. Gradually you can add challenges such as using a soccer ball and moving the ball in different directions. Another good method is to balance on one foot and play catch with yourself with a tennis ball against a wall or dribble a basketball. Start out with one minute at a time, and build up to 3-5 minutes.

 

Side Leg Lifts
Keep the back of the leg and buttocks against the wall. Slide the leg up the wall and hold at the top for 5 seconds then slide back down. Point toes down.

Start with one set of 20 each leg, after 1 week add a second set of 5. Every 2 days add 5 more as long as it is being well tolerated until you build up to 3 sets of 20 lifts.

 

Strengthening with Theraband
Loop one end and close in the door. Loop other end around the uninjured leg. Bend your knee on the injured leg and balance on the injured leg. Put your uninjured leg through a range of running motion, going up and back. Build up to 3-5 minutes, make sure to exercise both legs.

 

If these stretches are not helpful and pain persists or worsens over time, consult your doctor, as the injury may require professional treatment, or could be caused by another injury, such as a stress fracture.

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