By: Dr. Patrick O’Brien
You’re Doing It Wrong…
Looking back at what has now become my professional career as a Physical Therapist, it all got started with a bout of Iliotibial Band Syndrome (ITBS). I was a young triathlete at the time, primarily competing in short course races. I was really good at not warming up, doing no strength training, and doing too many speed workouts each week. I began having severe stabbing pain on the outside of my knee. It absolutely stopped me from running. The pain was sharp and severe and once it started during a run, the only way to get rid of it was to stop running.
I saw a local Physical Therapist, Gloria, who would later become my boss as an undergrad student, and then I returned to work with her when I first got out of PT school. She would become a mentor and friend along the way. So to that end I’m thankful I had ITBS…other than that I’d rather not have that ever again.
The IT Band is a thick band of tissue that runs from your thigh to your knee. At the hip it is connected to a small muscle called the tensor fasciae latae, at the knee it crosses over your lateral epicondyle of the femur and attaches to your tibia. The point where it crosses over your femur is where the inflammation typically occurs. The role of the IT Band is to assist with stability of your knee with dynamic movements (walking, running, jumping), but for the most part it is a passive mover in the process.
ITBS is one of the most common running injuries, and there are many myths regarding proper treatment.
Let me start with my first mind blowing piece of information: You don’t need to foam roll your IT Band…take a minute and get yourself back together. I know I just debunked all that time you’ve spent writhing in pain on your living room floor “fighting the good fight” as a diligent runner who always thought you were supposed to foam roll our IT Band. Stop. You aren’t helping. You’re just compressing a nerve and causing pain that in no way improves your healing or prevention of ITBS.
Rarely, if ever, is the length of the IT Band the culprit of the pain. I cannot remember the last time I had a patient “stretch” their IT Band. Furthermore, I’m not convinced it could or should be stretched. One of the most fascinating and memorable parts of cadaver lab in PT school was seeing how dense and tight an IT Band is in the human body. Seeing this made me even more sure that your ability to stretch this tissue is minimal.
The IT Band is a passive mover. Wherever your hip and knee take it is where it is going. If you repetitively put it in strained position, it will eventually become inflamed and stop you from running.
If your hips are weak, you are likely to put your knee in a compromised position, and thus you’ll end up with either ITBS or patellofemoral pain syndrome aka “runners knee”. It’s just a matter of which one you get first.
Once the initial inflammation is under control with rest, NSAIDs, and consistent use of ice, I move my patients into the strengthening phase. Good news: If you read my previous article “Your Hips Don’t Lie” you are already one step ahead. Those same exercises apply here. Once again, I’m beating the drum of hip strength and core stability. Maybe you are starting to see a pattern? I sure hope so. Get in the gym and do your hip strengthening and balance exercises, stop foam rolling your IT Band, and keep the speed work down to once a week.
If you don’t want to make the time for strength training, make sure you save some time for physical therapy.