Iliotibial Band Syndrome. Every runner has heard of this injury and in a sports chiropractic clinic like Mobility 4 Life, we see it a lot. Now it afflicts more than just runners--typically anyone that performs a high repetition of only one or two activities like running, biking, CrossFitting, hockey, etc can experience this frustrating condition. It's imbalances of the core and hips that lead to the pain on the outside of the knee associated with the condition. Let's take a brief look at what happens:
Iliotibial Band Syndrome
In an ideal world, our hips are very flexible yet very stable at the same time. For most of us, however, this just isn't the case. Many of us are afflicted with hip instability during our day-to-day movement. Now this isn't a painful condition so you may not even know you have it. This might be you if you notice the following conditions in your hips:
- Frequent Clicking
- Frequent Cracking
- Stiffness in The Muscles Around The Hip
- Pinching Deep in The Hip
A result of this instability in the hip causes the joint moves around too much. The muscles around the hip, including the tensor fascia latae (TFL) will then over-engage leaving them stiff and tight. Now, the TFL is unique in that its muscle fibers converge into more dense connective tissue as it descends down the outside of the thigh. It becomes the '"liotibial Band." This band of connective tissue inserts just below the knee on the outside of the tibia or shin bone. This particular tissue passes over two different joints, there are many forces on it, and it is prone to becoming overwhelmed--this is what we know as "Ilioitibal Band Syndrome."
While healing any inflamed tissue or structure, it's always recommended to TEMPORARILY take a break from the pain-offending activity. Don't worry, we'll get you back to it later. What we need to do is teach the hip and knee to move with better stability and less inappropriate "wiggle" or movement deep in the hip joint. Here's how we do that:
Step #1 - Loosen Overly Tight Muscles and Improve Flexibility of the Hip Muscles
Often, there are non-painful muscles of the hip that need to be "released" (or lengthened) to allow the ideal balance and posture of the hip to return.
Step #2 - Strengthen/Stabilize to Reduce Inappropriate Motion in the Hip
So now that we've loosened up any overly tight muscles around the hip, we want to upload a new hip "software" to teach the core musculature around the area to properly move and control the hips when we move our body. We start this off with some nice Side Planks, which is my favorite way of improving the lateral or side-to-side stability and control of the body.
As we progress we'll start looking at more weight-bearing exercises such as the Chop and Lift exercise. When you build up to the this exercise, make sure you do not allow excessive knee deviation to the mid-line during the Chop and Lift. Walking or running with excessive mid-line deviation of the knee is how this problem started in the first place, so make sure to not let that happen.
The Great Foam Roller Debate
"Should I Roll Out My IT Band with a Foam Roller?"--a very frequent question on this topic. There are all sorts of opinions on this issue. In the past it's been recommended to "roll out" your ilioitibial band with a foam roller to help provide relief for this condition. Most people report that while rolling out their IT band, they find that it is a very painful process. Some people report that afterwards, it provides them relief. Many do not. My personal opinion is that the more important aspect of this recovery is to focus on the exercises that re-train how you move your hips and core. So make your own opinion. If you like rolling out your IT band and it helps, then go for it. If you don't enjoy it and it doesn't help, that's fine too. Personally, I wouldn't recommend it but if a patient of mine said they roll it and they feel like that makes them better, then I'd tell them that I don't have a problem with you continuing that practice.
It's important to understand the mechanism of any injury, what we can do to recover, and what changes we can make so that this no longer limits us from performing the activities we love. My greatest recommendation for people suffering from this condition, other than the specifics of recovery, is to more frequently change up your choice of activity. If you're only form of exercise is singular (only running, biking, walking, or hockey, etc), then this injury will probably come back sooner or later. Try to make a regular practice of performing different sports or fitness types. Good luck and please leave any questions or comments below!