Hip and Knee pain? Could it be….your IT Band?

Do you suffer from hip and knee pain? The culprit could be your IT band (iliotibial band). It helps to extend, abduct, and rotate your hip due to its insertion on your muscles. Because of its attachment points on your hip and outer most shin bone, it crosses two joints, increasing the chances of causing pain/dysfunction. You could experience pain only at your hip, only your knee, or both. The area could be tender to the touch, but if it is tender to the touch and is painful with activity then you may have IT Band Syndrome. The good news… it’s treatable and manageable.

Anatomy As seen in the picture above, the IT band is the white tissue that runs along the outside of the leg. It attaches at your hip then travels down the outside of your thigh attaching just below your knee. It’s a long piece of connective tissue, or fascia. Fascia is a sheath that encloses muscles, connects muscles to bone and compartmentalizes muscles that serve a similar function. The IT band is the largest piece of fascia in the human body. It is surrounded by your glutei, quadriceps, and hamstrings. You can image that if one of those muscle groups has a dysfunction or injury, it would affect the IT band as well. It is a simple yet strong structure. The band is crucial to stabilizing the knee during running, as it moves from behind the thigh bone (femur) to the front of the femur during activity. The continual rubbing of the band over the outside of the knee, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Causes

Training Habits – Consistently running on a horizontally banked surface, such as the shoulder of a road on which the downhill leg is bent slightly inward (causing stretching of the band against the thigh bone) – Inadequate warm-up or cool down – Excessive up-hill and down-hill running – Positioning the feet toed-in when cycling – Running up and down stairs or stadium – Hiking long distances – Rowing – Breaststroke – Treading water

Abnormalities in leg/feet anatomy – High or low arches – Striking the outside of your foot more (supination) – Excessive lower leg rotation due to your foot caving inward, putting more weight through the arch of your foot (over pronation) – Uneven leg lengths – Bowlegs or tightness about the IT band

Muscle Imbalance – Weak hip abductor muscles – Weak/non-firing multifidus muscle – Uneven left-right stretching of the band, which can be caused by habits like sitting cross-legged

Symptoms The symptoms can range from a stinging sensation at the knee to swelling of the tissue in the area where the band moves over the thigh bone (femur). The sensation at the knee can also be felt along the entire length of the IT band. The pain may not be present immediately during activity, but can progressively get worse. Typically, pain is felt when the foot strikes the ground. The pain can persist after the activity is over and may be felt above and below the knee.

Treatment Stay tuned for Friday’s post about how to treat your pain, improve your mobility, and start to improve your muscle imbalances. Treatment typically consists of Physical Therapy and Massage. Some MDs will prescribe anti-inflammatory or a low dose steroid, however, these medications are not necessary. There is also an option of surgery, however, it is VERY rare. Try Friday’s exercises before pills or a knife!

Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.