What Really Causes IT Band Syndrome Pain (And How Do You Fix It)?
IT Band Syndrome: The Cause (and Solution!)
Pain down the outside of your leg?
It’s a sign something’s not working right. Pain, contrary to popular belief, is your friend – it’s your body’s way of signaling to you that something needs your attention.
One of the most common causes of knee, hip and outer-thigh pain is something called IT band syndrome (ITBS). This is especially true if you’re a runner, cyclist or hiker. And if IT band syndrome is something you’ve dealt with, you know it’s an incredibly painful and frustratingly-stubborn injury to deal with.
Fortunately, you don’t just have to suffer through it.
What is IT Band Syndrome?
The IT (or iliotibial) band is a thick, elastic layer of tissue that originates from the iliac crest above your hip, runs down the outside of your thigh and attaches just below your knee. It’s a ligament, because it connects two bones, but it’s also a tendon because it attaches to the tensor fasciae latae and the gluteus maximus muscles. The iliotibial band helps stabilize and move the knee joint, taking work off the muscles in your legs while you’re standing, walking and running.
IT band syndrome causes pain mainly on the lateral (outside) side of the knee, especially when going up and/or down stairs and hills. But it can also cause pain directly over the hip (it’s closely associated with something called trochanteric pain syndrome) and along the entire outside of the thigh. Sometimes ITBS causes a feeling of clicking, popping, or snapping on the outside of the knee.
Technically, IT band syndrome is classified as a repetitive strain injury because it occurs when there’s too much “rubbing” between the iliotibial band and the structures underneath it. Like many other overuse injuries, it most often plagues runners, cyclists and hikers. It accounts for 5% of all lower extremity injuries in distance runners.
But that’s not really the whole story, because runners that suffer from ITBS usually start feeling pain just a few minutes into their runs, and it occurs in plenty of inactive people as well. More on that in a second.
IT band pain is in contrast to patellofemoral pain syndrome (PFPS), which causes diffuse pain on the front of the knee under the kneecap and often gets mixed up with iliotibial band syndrome.
Because of the location of the pain, it’s also commonly mistaken for a lateral meniscus tear. However, meniscus pain is deep inside the knee, while IT band pain is fairly superficial — on the side of the knee joint, not in it. Meniscus tears will also usually cause significant swelling inside the knee, unlike ITBS.
Conventional Thinking on IT Band Syndrome is Wrong
Conventional thinking says that iliotibial band syndrome is a kind of tendinitis. If the IT band is too short/tight, it rubs painfully over a bump of bone on the outside of the knee called the lateral epicondyle. For this reason it’s also commonly called iliotibial band friction syndrome.
So the traditional treatment by physiotherapists, athletic trainers and sports chiropractors has been to stretch, foam roll and use myofascial release techniques on the IT band. And then when you get home, do it again. And when you get tired of that, do it some more for good measure.
Makes sense, right?
Well… science has shown that that’s not really what’s going on. In a 2004 study at the University of Connecticut, researchers looked to identify factors that would predispose soccer, field hockey and basketball players to various knee injuries. So they measured the participants for all the things commonly known to be risk factors for various knee problems, including the tightness of their iliotibial bands, and kept track of them throughout their respective sports seasons.
But the researchers didn’t expect what they discovered in regards to IT band syndrome. None of the participants who developed ITBS (and there were plenty – it was the most common injury in the group) actually had shortened/tight iliotibial bands. Not even one!
The takeaway? Tight iliotibial bands aren’t the enemy. More recent research has shown that the thick fascia that makes up your IT band can’t actually change length. A 2008 study determined that it would take 2,000 lbs of force to lengthen your iliotibial band just 1% – far beyond any human’s physiological limits.
To rock the boat even further, what’s causing the pain in ITBS isn’t actually the iliotibial band at all.
However, that doesn’t mean iliotibial bands can’t be tensioned by abnormal positioning of the structures it attaches to. And it doesn’t mean the IT band can’t thicken in response to extra stress.
Pelvic Alignment & IT Band Syndrome
The one thing that did correlate with higher risk of ITBS in the UConn study? An increased Q angle – or how far your hip and knee angle inward. It’s easy to see why. The amount of tension being put on your iliotibial band is directly associated with how far your knee tilts inward.
Here’s where what we do at Ascent Chiropractic comes in: Q angle has everything to do with the alignment and positioning of your pelvis. When your pelvis (or more specifically, the iliac bone of your pelvis) tilts forward, it causes femoral anteversion (internal rotation of your thigh) and significantly increases your Q angle.
It’s the reason why research has shown that those with IT band syndrome almost always have weak glutes and hip abductors – weak glutes are a defining feature of anterior pelvic tilt. It also explains why women (who tend to have a more anteriorly-tilted pelvis and bigger Q angle) are more than twice as likely to suffer from ITBS as men.
You can try it yourself: while standing, tilt your pelvis forward (stick your butt and gut out), and notice what happens to the positioning of your knees and the tension on your IT bands. You’ll see your knees angle inward and feel extra tightness in your IT bands. Then shift your pelvis back to neutral. Notice the difference?
So What’s Causing the Pain?
The iliotibial band, like soft tissue pretty much anywhere in your body, will thicken in response to tension being placed on it. It’s basically your body’s way of reinforcing tissue that’s dealing with extra wear and tear. But that’s not actually the source of pain.
In reality there’s a highly-sensitive fat pad that’s located directly beneath the iliotibial band that a thickened, tensioned IT band will eventually start to compress. Compression leads to reduced blood flow through this fat pad, which then leads to inflammation and pain. This compression is why aggressive foam rolling, myofascial release or stretching by itself – without fixing the underlying problem – can sometimes make the inflammation even worse.
The good news? You don’t just have to sit around hoping the pain goes away by itself. Fixing IT band syndrome is a two-part process:
1.) Reduce the inflammation of the soft tissues that sit underneath the IT band. A few days of rest and ice are almost always the first step towards recovery, usually followed by some combination of stretching, myofascial release therapy, IASTM/Graston therapy, therapeutic taping and working with a foam roller and/or mobility tools.
And, even more importantly:
2.) Correct the biomechanical problems that caused the problem in the first place. Unfortunately, while it’s fairly easy to self-diagnose IT Band syndrome, it’s a little more difficult to identify exactly what needs to happen biomechanically to get anterior pelvic tilt, femoral anteversion and an increased Q angle corrected without the help of a professional.
Any treatment plan will need to be customized to specifically address what’s going on in your body – and that can mean correcting joint dysfunction and muscle imbalances in your pelvis, hips, knees, ankles and even your feet.
The Ascent Chiropractic Difference
There’s a reason so many patients choose us – we’re experts in the biomechanics of everything from your head to your toes, and we combine the best of both chiropractic and physical therapy treatments. So if you’ve been self-diagnosing, living in the pharmacy aisle, or dismissed by doctors, trainers and therapists who aren’t interested in actually figuring out what the problem is, it’s time to get the answers you deserve.
Ready to get started?
Make an appointment at Ascent Chiropractic by calling 262-345-4166 or using our online scheduling app.