Down On Our Knees
Researchers Rethinking IT Band Syndrome
The IT band doesn’t make music, but if it did the tune would be confusing.
The iliotibial band, or the IT band, is a large, incredibly strong tendon that runs from the hip down the outside of the leg to the shin. IT band syndrome, or ITB syndrome, is a common source of knee pain in runners and other outdoor enthusiasts that is thought to be caused by friction from movement of this band over part of the knee.
ITB syndrome generally occurs in runners as an outcome of overuse, resulting in debilitating pain and inflammation of the knee’s outside portion. Since it is so common, health professionals and athletes alike strive to find the best way to avoid ITB syndrome or fix it when they have it—and here lies the controversy.
ITB band syndrome is highly misunderstood because its cause isn’t completely clear, and neither are treatment options. Some blame this on the fact that it hasn’t been the subject of much professional research.
Many criticize some of the current practices for dealing with IT band syndrome, as they can be medically unfounded and largely ineffective.
IT band syndrome is often called IT band friction syndrome, because some say that the syndrome is caused by the IT band rubbing back and forth over the small bone protruding from side of the knee, called the epicondyle. Proponents of this theory say the area therefore becomes sore and must be rested in order to improve.
But research from Wales and some American universities has shaken the roots of this theory. John Fairclough of the University of Wales School of Sport and Physical Recreation and his colleagues did intensive studies of IT band sufferers and studied IT band anatomy with cadavers and MR scans of healthy individuals.
They found that modern understanding of IT band syndrome was lacking.
For starters, the IT band shouldn’t be thought of as an independent structure of the leg. The thigh is entirely covered by what is called a fascial sleeve, and the IT band is simply a thickened portion of that band. Therefore, if the IT band is moving across the bony protrusion on the outside of the knee, the whole thigh casing would have to be moving too.
“The perception of movement of the ITB across the epicondyle is an illusion caused by alternating tension in its anterior and posterior fibers,” the authors of the study wrote.
Translation: there really isn’t anything moving across your knee with IT band syndrome. Fairclough explains that there is a layer of fatty tissue on the knee underneath the IT band. As the IT band tenses up and the knee flexes, this fatty tissue, rich with nerves, feels the pressure. This is what causes the pain.
Other research supports this finding. Doctors in Belgium performed arthroscopic surgery (a surgery performed with a camera inserted into the knee) on 36 athletes with IT band syndrome, resecting the recess of tissue on the knee, doing nothing to the band. All of the athletes went back to sports in three months and 32 reported good or excellent results of the surgery.
While there is debate over what exactly happens to cause the knee pain, the exercise of those suffering from ITB syndrome often shares similar characteristics. IT band syndrome often comes to runners who are overtraining, running on worn shoes, or running on slanted surfaces.
If you run on a track, change directions often. If you feel pain on the side of your knee, the best option is probably to stop running and rest for a few days. Those worried about losing fitness can start cross-training.
There are dozens of suggested remedies for the syndrome, including everything from injections to stretching to massage. Fairclough’s research, however, found that many of these remedies are unfounded.
“ITB syndrome is related to impaired function of hip and leg musculature and its resolution can only be achieved through proper restoration of lower quadrant muscle balance,” he writes.
Many say that muscle strengthening, and not stretching, is the answer. Men’s Health suggests strengthening the gluteus medius, which helps raise your thigh out to the side, and the gluteus maximus, your rear end.
Canadian therapist Paul Ingraham sits on the editorial board of Science-Based Medicine, and has written an entire e-book on the IT band syndrome debate. He suggests rest and properly-timed icing, among other things. Many athletes don’t allow their syndrome enough time to heal, returning to previous exercises with vigor their body can’t take. Temporarily stopping the activity that causes the knee pain might be the most effective way to get rid of IT band syndrome.
In his e-book, Save Yourself from IT Band Syndrome!, Ingraham explains the newest research about IT band syndrome and flaws in current practice. He says there are three main myths:
1. It’s a hip and thigh problem. IT band syndrome is characterized by a burning pain in a specific spot on the outside of the knee, but many people mistake their hip and thigh issues for IT band syndrome, since the band extends from the hip to the shin.
2. Steamrolling will help. Steamrolling is when athletes take a foam roller (there are dozens of kinds), and lay on their sides, on top of the roller. As the person moves up and down, it massages the thigh, or whatever part of the body you are resting on. The roller supposedly decreases tension on the IT band. The problem with this as treatment is that the IT band is virtually indestructible, according to Ingraham.
“It works about as well as it would on a truck tire,” he writes.
Furthermore, loosening thigh muscles, common targets for foam rollers, doesn’t really do much for the IT band. The IT band does connect to other muscles, however, like the gluteus maximus (butt), so massages can help ease tension, if done in the right places.
3. Stretching will help Ingraham says that common stretches prescribed for IT band syndrome are largely ineffective, in part because of the IT band’s tough nature, and in part because stretching isn’t proven to do anything for this specific problem.
While some consider IT band syndrome a common injury with common treatment, it may be more complicated than previously thought. Understanding what science has said so for about the syndrome can help us prevent the problem, or fix it with greater efficacy.