IT band syndrome is one of the more common referrals that I see. The patient typically comes in complaining of lateral thigh and/or knee pain and the default diagnosis is IT band syndrome. Although it is a very common issue, the IT band not always the culprit. I’d say at least 50% of the time, it doesn’t even end up being IT band syndrome. There are other causes for the same symptoms, which is what I’m writing about in this post.
What is the IT Band
The IT Band is not a muscle or ligament. It’s actually a thick band of connective tissue that connects the hip to the knee. It forms from the Tensor Fascia Lata, Gluteus Medius and Gluteus Minimus muscles in the hip. It then runs down the lateral side of the thigh and connects just below the knee. At the distal end of the IT band (lateral side of the knee), a bursa sac provides a buffer between the bone and the IT band. The bursa sac is a fluid-filled sac that decreases the friction between the bone and IT band.
In terms of function, the IT band helps with hip abduction (moving the hip out to the side), knee flexion (bending the knee) and extension (straightening the knee). As the muscles in the hip contract, it pulls on the IT band, which assists with those actions above. In addition to connecting the hip to the knee, the IT band also provides additional stability for the knee.
What Is IT Band Syndrome
IT Band syndrome refers to an inflammatory process at the distal end of the IT band (lateral side of the knee). It is caused by excessive friction between the IT band and the bursa sac. It is typically considered an overuse injury because it occurs with repetitive movement and not trauma. Runners develop IT band syndrome for a number of reasons, including
- Training errors
- Muscle Imbalance
- Leg length discrepancy
- Running on a slanted surface
Pain starts at the distal end and will commonly move up the thigh along the IT band. Like with many of the other overuse injuries, IT band syndrome can become chronic. And like other chronic conditions, when it becomes chronic, it is much more difficult to treat.
How Do You Fix IT Band Syndrome
First, you need to correct any training errors, muscle imbalances, leg length discrepancies and/or what type of surfaces you are running on.
Strengthening the hips is key in helping treat and preventing it from returning. Need some good exercises for strengthening the hips? Check out this post that I did on my top 5 favorite glute exercises.
Many leg length discrepancies are not true leg length discrepancies and can be fixed with adjustments to the pelvis. True leg length discrepancies can be fixed with wedges in the shoes.
Surgery can be an option for those who develop excessive scarring and can’t get pain under control. However, this is rare. Most respond to conservative treatment.
What Also Causes Lateral Thigh and Knee Pain
Nerve trauma, injury or compression can also cause pain in the same areas along the lateral thigh and knee.
Do you experience numbness or tingling?
Or pain in the buttocks on that same side?
Do you have a history of low back pain?
If you answered yes to any of those, you may want to further investigate your lumbar spine. I commonly see referrals for IT band syndrome, but then discover findings that don’t quite fit. Numbness and tingling, pain in the lower leg or history of low back pain makes me consider lumbar spine involvement.
When the symptoms are coming from the lumbar spine, the diagnosis falls under the category of a lumbar radiculopathy. Radiculopathy refers to compression of the nerve in the spine, which causes symptoms in the leg.
When I hear any of those symptoms above in addition to lateral thigh and knee pain, I always rule out nerve compression before I move forward with treatment of IT band syndrome. I see too many people who have seen other health practitioners and spent weeks and weeks in PT and not gotten anywhere with the symptoms. Why? Because they were treating the wrong thing.
How to Treat a Lumbar Radiculopathy
Most of the time a lumbar radiculopathy is due to a mechanical issue in the low back. This can be due to a disc bulge or just a malalignment of the spine causing the vertebra to pinch the nerve. In the vast majority of cases, it doesn’t really matter what’s causing it exactly. So no, most of the time, you don’t need an expensive MRI to tell you what’s going on. However, there are some red flags that do require imaging like inability to control your bowel or bladder or you suspect a tumor causing the problem. A medical professional will be able to assess for these.
Assuming you don’t have any red flags, what is important is finding the movement that restores mobility to the spine and takes pressure off of the nerve. Working with a physical therapist who specializes in mechanical assessment and treatment (look for MDT after their name) can help you find the right movement for you. You can also pick up a copy of Treat Your Own Back to help assess and treat your specific issue.
Due to the amount of time that we flex our spine, often times, extending the lumbar spine is helpful. However, it’s not always the case and the movement needs to be modified. Again, a properly trained PT or even the book listed above can help. Also, take a look at the post on posture. Posture is a key component in relieving and preventing low back problems. You can also find further information on posture in the Free Resources library.
If you’ve been struggling with IT band syndrome for a long time or know someone else who has, you may want to further investigate your low back. Don’t be too quick to point the finger at the IT band, especially if you have those other symptoms or your symptoms are not responding to treatment. It shouldn’t take 6 months to resolve IT band syndrome. There are too many races you could be doing during that time instead!
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