IT Band Syndrome: Solutions for Lateral Knee Pain
Iliotibial Band Syndrome (or IT Band Syndrome for short) is a common overuse issue that is related to lateral (outside) knee pain. The pain often felt is a sharp pain located slightly above the knee joint and along the outside of it. This will occur with long distance runners more than sprinters. It is also common with military recruits, soccer players, skiers, cyclists, tennis players and adolescents going through a growth spurt. Without getting too scientific, the following is a breakdown of what is happening.
When you repeatedly flex and extend your knee (think running or cycling), your IT Band will tighten and constantly rub on the lateral condyle of your femur. To feel this condyle, get in a seated position run your hand down the outside part of your thigh. When you get to the outside part of your knee, you should feel a small bump. The small bump is the lateral condyle of the femur. That constant rubbing over time can irritate and inflame your bursa sac if you overuse, have bad running form, ill fitted shoes, running on uneven surfaces etc. Picture 1 is an anterior image of your right leg. The thin grey line is your IT Band and the red circle next to it is an inflamed bursa due to the irritation from the band.
Pic 1 (Front view) Pic 2 (Side view of Gluteus Medius)
There may also be some muscle weaknesses occurring here as well. With many overuse injuries, it is the result of a muscle imbalance. For those with IT Band Syndrome, the muscle imbalance occurs along the hips. The weak, under-active muscle along the outside of your hip is a muscle called Gluteus Medius (see pic 2). The main function of the Gluteus Medius is to abduct your hip (stand and raise your leg out to the side) and depress your pelvis. Basically, this muscle will stabilize your pelvis every time you walk or stand on one leg by pulling the pelvis down. By pulling it down it keeps your hips level and prevents any sagging.
A tight or overactive muscle within this condition is a muscle called Tensor Fascia Latae. Not only will this muscle abduct your hip, but it also flexes it (think when you run and take your first step, you hike your leg up to start your movement. That ‘hike’ is hip flexion). When you run constantly, this muscle becomes very tight because you are using it so often.
Now that we know the anatomy of this issue, the question now is how do we fix it?
Here are some common solutions to the problem:
1. Hip Flexor stretch.
Below is a picture of my friend, Mike, stretching out his hip flexors. Start by kneeling on the ground with your left leg planted at 90 degrees and right leg is bent with your knee on the ground. In that position, jet your hips forward until you feel a stretch along the back leg. Hold for 20 seconds and repeat two to three times
2. Hip abductors stretch (outer thigh).
For this stretch, take your right leg and cross it behind your left. Bend both knees slightly, lean your body to the left as you jet your right hip out.
3. Strengthen your outer thigh with Stability Ball (SB) Hip Abduction. Take a SB and place it against a wall. Lay your side against it so that your body is at a small slant. The SB should be resting along the outside part of your ribs and your arm can rest on top of the ball. From there, raise your outside leg to the side as high as you can and slowly bring back to the start. Do three sets of 12-20 reps. You can also progress this exercise to placing an ankle cuff band around the ankles and perform the same movement.
4. Standing on one leg will force the Gluteus Medius on the stable side to contract to keep you stable. You can progress this to a single leg squat.
5. Tube Walk. Start by placing an ankle cuff around your ankles. Keeping your knees and hips slightly bent begin by laterally shuffling across a gym, hallway or small area. Make sure that you keep the tension in the cuff throughout the exercise and don’t drag your inside leg as you move.
Try these exercises out the next time your knee feels painful after a run or other cardio event. But remember, to get a true diagnosis of your lateral knee pain make sure you see your physician.