ITB Syndrome is a common and quite painful leg/knee injury that can leave runners, triathletes, and even cyclists out of commission for months. It often presents itself as pain on the outside of the leg, typically near the lower part of the knee. In this video Sock Doc discusses the reasons for ITBS – muscle imbalances, anaerobic excess, improper footwear - as well as treatments you may want to consider, including those you should avoid such as icing, stretching, and orthotics. Read more about Iliotibial Band Syndrome.
Hey, this is the Soc Doc, and today I’m going to talk about a common injury. It’s called iliotibial band frictional syndrome, also known as ITB syndrome. It’s pain on the outside of the leg, most often in a runner’s knee. It’s like an ice pick sticking in the outside of your knee, a really tough pain to be dealing with. Most runners have it for many months, sometimes even a half a year, where they can’t run, or they’re hobbling home after a short little run. It tends to get worse and worse. Unlike planar fasciitis, which I talked about in my last video, which tends to get better as you walk on it, usually, the iliotibial band frictional syndrome, that pain only gets worse the more you use it.
So iliotibial band is actually a band of fascia that comes down the outside of your leg here, and attaches to the outside of your knee. That’s most often where the sharp pain is, like an ice pick. The iliotibial band is an extension of two muscles. One is the tensor fasciae latae, which is up here on the side of the hip. The other one is the glute max muscle, which is your powerful butt muscle that comes all the way down and actually intertwines with the hamstring, here. About three-quarters of the way down your leg, the connective tissue is. So with your tensor fasciae latae up here, and your glute max, those fibers come down and wrap around, and make up your iliotibial band. Basically, the iliotibial band, it’s right around 25 percent of the tensor fasciae latae, and another 75 percent of your glute max. That’s what many people disregard as the power in their glute max, and that fiber, those bands coming down and making up the iliotibial band.
A couple things you want to look for, for iliotibial band issues. One is you don’t want to ice it. Ice just tends to tighten up the iliotibial band. We don’t want to do that. Sometimes warmth will work, at least to get you over some general symptoms. It’s not going to correct the problem. We’re going to get more into that in a second. The other thing you don’t want to do to the iliotibial band is stretch it. When you injure a muscle or fibers, in this case, the fascia, you want to keep those connective tissue muscle fibers joining back together to one another. The more you stretch something, the more you elongate it, the further you keep the injury going. You’re basically going to prolong the injury the more you stretch something, especially the iliotibial band.
What are we looking at for the IT band? One is you might have an issue in that TFL. You might have an issue in the glute max. Couple things you can do is look for trigger points in there. See if there’s any tender spots in the iliotibial band, or any tenderness coming down the glute max, obviously on the same side, as it wraps around into that final insertion point in the iliotibial band. You don’t want to mess around with the iliotibial band. Stay off the band, especially the insertion point. It’s just going to cause more pain. So you’re looking to treat the muscles that make up the band, not the actual band itself. The second thing you’re going to look for is any problems with the lower leg. Look for trigger points on the inside of the tibialis posteri muscle, behind the tibialis, like I showed in the planar fasciitis video. Also look for any tenderness down in the shin muscle here, your tibialis anterior. Very commonly people get shin splints. So that’s another area to look at. A third area to look for tenderness, is the inside of the knee here. What happens is, I’ll show you on this side, there’s three important muscles that attach to the inside of the knee. When one, two, or even all three of these muscles fatigue, what happens is the muscles on the outside, and now a major part of the iliotibial band insertion, that spasms because of the weakness on the inside. You get an imbalance between the inside and the outside of the knee. Three muscles that attach right here on the inside of the knee are all related to your adrenal glands.
When someone’s under a lot of stress, that means anaerobic workouts, training at too high a heart rate, racing too much, someone who’s under too much mental or physical stress. They’re pushing themselves too hard, there’s family issues, there’s work issues. Those muscles are actually a very good reflection of how much hormonal stress you’re under. Even a poor diet will do it. A diet with hydrogenated fats in it, MSG, too much refined sugars, will actually affect the muscles of your knee, and these inner knee muscles here that support your joint. Then you can end up with a spasm in that band as it tries to support the area. So a big key point here is that the iliotibial band is a reflection of other things off in your body, in this area, and it’s trying to support the problem. So we’re not going to fix the iliotibial band by fixing it directly, but by addressing the root cause of it. In this case, if you have tenderness right in that area, it could very well be because you’re under a lot of stress, and it’s an adrenal gland issue.
The fourth area we’re going to look at is gait. What happens is, if she had an iliotibial band issue on this side, every time she steps forward with her right leg, these muscles in the front of the thigh should be firing. In a normal gait position so should the muscles on the upper body, on the opposite limb, so this arm muscle. As these work, these work in harmony. As you switch your gait to this leg, as this leg goes forward, the extensor muscles on this side, so her glute max now on the right side, as well as the triceps on this side, are also firing. That’s how someone normally walks. Let me do it correctly. Like this.Extensors on the opposite sides are firing in regards to your lower leg muscle and your upper arm muscles. So triceps and glute max, here, on this side, and here, and then flexors on the upper body, and flexors on the lower body, on the leg that’s forward. So she steps forward. If she was having an iliotibial band on this side, as she steps forward, and these muscles aren’t supporting her well, maybe her tensor fasciae latae is a flexor, making up part of that iliotibial band. That could be because of a flexor problem, maybe a bicep problem, maybe a shoulder problem on the opposite side. Or the extensor problem, if it was her glute max, which makes up 75 percent of that iliotibial band, that could be fatiguing on her because of an extensor problem on this opposite side. Maybe in the triceps, back of the shoulder, or that area. She actually needs to be looking to treat this area. Maybe there’s some involvement up there. Maybe there’s some imbalance that she could investigate with her therapist or doctor. Don’t disregard the gait. It’s a big deal. So that’s three areas. We’ve got the local muscles again, tensor fascia latae, we’ve got the glute max, that’s considered one, two is the inner knee muscles. If it’s an adrenal gland issue it might be tender there. Three is the lower leg muscles to support the knee joint. Four is the gait imbalance. Five is actually the foot muscles.
The strength of the feet, like I talked in the planar fasciitis video, is very important for your gait. Very important to support the rest of your body, pronation, shock absorption. Go barefoot as much as possible, like I’ve always preached. Stay away from those orthotics. The more you wear orthotics, the more you’re going to fatigue your feet, throw off your gait, and eventually end up with a problem. It could be an iliotibial band problem. It could be planar fasciitis. It could be a shoulder muscle problem from the way that you’re throwing your gait off. Think minimalist shoes, too. She wears Nike Frees 3.0. Pretty good minimalist shoes. Lots of others out there. Remember when you’re buying shoes, keep them nice and level. Not much of a drop, not much of a heel on them, and you should be able to bend them in any direction. Good old Nike Frees have grooves in them. There’s the rock stuck in there. You should be able to turn them and twist them in any direction possible, and a nice light toe box for the toes to splay out. When you’re not wearing shoes, try to be barefoot as much as you can.
Watch the feet. Look for the adrenal gland issues. Look at those other muscles that you probably haven’t considered before. No icing. It’s just going to tighten that IT band up more. No stretching. It’s going to irritate the fibers and elongate and stretch them, and stretch out the length of your injury. Look at the opposite gait. Don’t forget about that glute max importance, especially if you’re a cyclist or a runner. It’s pushing up hills. Big muscle to use. That’s it. Thanks for watching.