A common overuse injury for long distance runners, cyclists and other endurance athletes is lateral (outside) knee pain. One of the most common causes is what is known as iliotibial (IT) band syndrome.
What is the IT Band?
The IT band is a thickening of the fascia lata that wraps around the whole thigh like plastic wrap. It runs from the TFL and gluteus maximus muscles at the top side of the hip. Further down the leg, it attaches to the lateral femoral epicondyle of the femur and crosses the knee joint into the patella (knee cap) and Gerdy's tubercle, on the tibia.
Image 1: Franklyn-Miller A. Et Al. Clinical Sports Anatomy. Melbourne: McGraw-Hill, 2010; p. 269
What is the IT Band for and why does it hurt?
The IT band works with muscles in your hip and leg for stability. It's a necessary connective tissue but it can become irritable for a few reasons. The exact cause and mechanism of IT band irritation is still debated among researchers but there are several factors that contribute:
Training errors such as increasing distance or speed to quickly
Running downhill more
Running on uneven or sloped surfaces
Narrow or long running strides
Muscle weakness through the outer hip
Image 2 Modified Illustration from Anatomy & Physiology, Connexions
What can be done to rehab it?
Despite popular belief, the IT band itself cannot be stretched or lengthened. Treatment should look at addressing the whole chain of the lower limb starting at the foot and up to the hips and core.
In the early stages, pain can be reduced by decreasing tension in the quadriceps muscles, glutes and hip flexors. This can be achieved via IMS (intra-muscular stimulation) / dry needling, soft tissue techniques, massage or stretching prescribed by your physio. In the later stages or chronic cases of IT band irritation, focus should be directed at strengthening the whole lower limb, including the other side to address asymmetries. Having a physiotherapist assess your hip and leg strength is important for individualized exercises to minimize your time away from running. Stay tuned for more information on common running injuries and what physio can do!