IT Band Research

A few weeks ago, I had to write a short paper about a common lower limb injury and provide the mechanism for injury, muscles involved, treatment, and rehabilitation for the injury.

Below is the paper with the scientific resources to back up the paper. These resources came exclusively from peer-reviewed articles. So, if you were interested in knowing more about your favorite lateral fascia, here you go! It’s science.

(Image courtesy of Anaerobic.net)

(Image courtesy of Anaerobic.net)

(If you copy or quote any portion of this paper, you must cite me as a source and/or the sources cited within the paper and notated below)

Illiotibial band syndrome

By Abigail Bales

Illiotibial band syndrome (ITBS) is responsible for approximately 22% of lower extremity injuries.(5) It is especially prevelant in the growing number of both professional and amateur long-distance runners due to repetitive nature of the movement of the knee, specifically the flexion of the knee.(3) It is the most common lower-limb injury in long-distance runners. The illiotibial band is a thick fascia that extends from the muscle fibers of the gluteus maximus and medius as well as the tensor of fascia latae, over the lateral femoral condyle of the knee, and attaching to the infracondylar tubercle of the tibia.(2) The causes of the injury are multi-faceted, though most recent studies focus on hip adduction, knee internal rotation, hip flexion, and overall kinematics of the individual. Training factors and terrain can also contribute to cases of ITBS. All, in part, seem to be to blame. This suggests that weak hip abductors and glutes, improper form, and speed of the movement are the root causes of the injury.(1,3)

Athletes experiencing ITBS often complain of knee pain located near and around the lateral condyle of the femur and/or hip pain localized near or around the greater trochanter of the affected leg. In mild cases of ITBS, symptoms may come and go during various activities, dissipate during exercise, and become aggravated on certain terrains or during rest.(4) In its most severe form, many athletes will find the pain so severe that they are unable to participate in running or cycling activities entirely.

Surgery is rarely necessary and is not recommended as a treatment for ITBS. Common treatments include rest, reevaluation of training and mileage, strengthening exercises, stretching, and myofascial release techniques. There are conflicting theories about the role played by the hip abductors, and subsequent strengthening of them, in ITBS. While studies point more to over all body mechanics and running form as the root cause of the syndrome, including over-adduction of the hip, hip abductor strengthening is routinely part of the rehabilitative process prescribed by physical therapists.(1)

Dr. Michael Fredericson, a professor at Stanford University who has done extensive research on ITBS, found in his 2000 study that, “Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners” and found that “after 6 weeks of rehabilitation, 22 of 24 athletes were pain free with all exercises and able to return to running, and at 6-months follow-up there were no reports of recurrence.”(2) This study focused on improving gluteus medius and minimus strength (hip abductors) and stretching as a treatment for ITBS in males and females from the Stanford University Cross-Country and Track teams.

The literature calls for abductor strengthening exercises, such as side-lying lateral leg raises with ankle weights, side-stepping straight leg walking with resistance bands, in addition to foam rolling, stretching, and massage as the best and most common forms of treatment for ITBS. In addition to treatment, complete rest from hip flexion activities would be prescribed, with return to small amounts of activity over time, so long as symptoms did not return.(2) Gait analysis and speed of running are also to be considered as a part of the rehabilitation and preventative process since ITBS occurs less in faster runners,(3) presumably because their form is better than that of slower runners.

References

1. Ferber, Reed, PhD, CAT(C), ATC, et. al. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic and Sports Physical Therapy. February 2010. Vol 40 No. 2. 52-58.

2. Fredericson, Michael, M.D., et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. July 2000. Vol 3. 169-175. PMID: 10959926. http://www.ncbi.nlm.nih.gov/pubmed/10959926

3. Fredericson, Michael, M.D. Illiotibial band syndrome in runners: innovations in treatment. Sports Medicine. 2005. Vol 5. 451-459. PMID: 15896092. http://www.ncbi.nlm.nih.gov/pubmed/15896092

4. Khaund, Razib M.D. Flynn, Sharon H., M.D. Iliotibial Band Syndrome: A Common Source of Knee Pain. American Family Physician. April 2005. Vol 8.1545-1550.

5. Linenger JMCC. Is iliotibial band syndrome overlooked? Physicians and Sports Medicine. 1992. Vol 20. 98–108.

Now go out and run!

The Great Illiotibial Band Mystery

Raise your hand if you’ve ever had Illiotibial Band Syndrome.

*Hand up*

That mysterious pain on the outside of your knee or hip that hurts more the more you run? That’s the one. If you’ve been a runner for more than a month, you’ve probably come across some IT Band problems. It’s such a common issue for runners that it gets its own post!

Hello, little band. You are a big pain in the butt.

There are a couple of things to understand about the IT Band:

  1. It’s fascia, not a muscle.
  2. Its origin (upper attachment) is on the muscle belly of the Tensor Fascia Lata (which attaches to the hip) and the iliac crest and girdle (hip).
  3. Its insertion (lower attachment) is to the femur (thigh), the patella (knee) and the tibia (shin).
  4. In a cadaver, the fascia is about as thick as tissue paper but wicked-strong.

Because the attachment sights are at the hip and the knee/shin area, the wider your hips are, (or more knocked-kneed you are) the more prone to IT Band problems you will be. This is why women experience more cases of IT Band syndrome than men. Yet another awesome anatomic anomaly in favor of the fairer sex. Yay.

Essentially, it is the job of this fascia to stabilize both the knee and hip. It is tense in both extension and flexion of the knee (when you bend and straighten it = all the time) and it is also involved in hip abduction (moving your leg out to the side). What does this mean for runners? Well, it’s always working. In every direction. For the whole run.

Ergo, without proper training it gets pooped out easily.

Why IT Band Syndrome happens:

  1. Your hips/glutes are weak.
  2. You add too much mileage or speed too soon.
  3. Your shoes suck.
  4. Your gait is wonky.

These problems are easily fixed by the following methods:

  1. Hip/Glute strengthening exercises.
  2. Stretching (live in half-pigeon for a while).
  3. Only add 10-15% more mileage every week (and cut back if you have pain).
  4. Foam roll your hips and glutes.

See? The IT Band isn’t so scary now that you know what to do with it! You should really be doing all of this anyway to prevent IT Band (and other) injuries so get on it! If your pain persists after implementing these tips, lay off the running and see and orthopedist to make sure it’s not something more serious.

Happy trails!

Now go out and run.