Band Syndrome is one of the most common, and often most frustrating, running
related injuries. It is also easily corrected if diagnosed and treated early
before it becomes chronic. Iliotibial
Band Syndrome is one condition that often responds well to chiropractic
treatment because of the relationship between the pelvis and the muscles that
attach to the pelvis. If faulty
pelvic mechanics are evident (i.e. restriction in the normal joint play of the
pelvis) then the muscles that attach to the pelvis will not work as efficiently.
If they pull at a slightly different angle, they’ll often get tight and
sore. Stretching helps, by
alleviating some symptoms but it doesn’t correct the biomechanical
“Functional Balance is the Key to Optimal Performance”.
Iliotibial Band (ITB) is a thickening of the fascia, or the outer casing of the
muscle, that runs up the outside of the thigh.
Fascia is like a sausage casing and the ITB is a thickening of that
casing. It originates up by the top of the hip and ends on the outside of the
knee. You can feel your ITB when
you stand. It causes the outside of your thigh to become very firm and tight
while your thigh muscles remain more relaxed.
In fact, that’s one of the reasons we have an ITB – it holds our legs
straight when we stand, thereby allowing the bigger thigh muscles a chance to
rest. The two main muscles that are addressed when dealing with ITB syndrome are
the Gluteus Maximus (the buttock muscle) and the Tensor Fasciae Latae (TFL)
muscles. The TFL muscle is a little
muscle but it is responsible for most of the work while we stand, thereby
allowing the larger muscles to rest. You will sometimes hear ITB syndrome
referred to as the TFL syndrome – the two terms are synonymous.
Signs and Symptoms
(outside) knee pain – NOTE – very few conditions, other than a ligament
sprain, will present as lateral knee pain therefore this alone is often
is often worse after running, especially after climbing hills and often
aggravated by climbing stairs.
that is very sharp and stabbing.
associated with a ‘snapping hip’, in which the muscles that cross the
outside of the hip can be felt to snap or click walking or running.
may also present as lateral thigh pain more so than knee pain but is rarely
focused primarily in the hip or gluteal muscles.
often be attributed to some form of over-training – sudden increase in
mileage, hill repeats, etc.
lateral knee pain is being caused by the ITB pulling up on its insertion on the
outside of the knee. Underneath the
ITB near its insertion at the knee is a bursa.
Bursae are fluid filled sacs that decrease the pressure where rubbing and
friction occur. Continually
contraction of the TFL causes the ITB to be chronically tight and this puts
excessive pressure on the bursa and that bursa reacts by becoming inflamed and
swollen, giving you pain. The ITB was pulled tight by one of the two muscles
mentioned above – the TFL or the Gluteus Maximus.
Running up hills, for example, uses more of the glutes than running on
flat surface, therefore it will often trigger a bout of ITB pain.
That also explains why the pain is often aggravated by hill repeats.
The ITB can also be aggravated by running on uneven reads or on tight
indoor tracks, running in poor running shoes or if your foot pronates (arch
collapses). If there was an underlying problem with pelvic mechanics, this may
have contributed to the ITB problem. Just Think About it! You run with
both legs equally – why would one leg get ITB pain and not the other?
What To Do About It
off, if you have faulty pelvic mechanics you’ll have a lot of trouble getting
rid of ITB pain on your own. Stretching
probably won’t do it alone. So,
if you’ve been dealing with ITB for more than 2 weeks with just stretching,
ice, exercises, etc. and you’re not improving much, have a chiropractor check
your pelvic mechanics. We have seen numerous patients who have tried TFL
stretching, ice, ultrasound, etc. over the outside of the knee with little
success. That’s because the
problem is not at the insertion in the knee – that’s just where the pain is!
The problem is higher up. And with that said, it’s also important that
you remember which muscle is the bigger of the two and which muscle works more
when we climb hills. The Gluteus
Maximus is often overlooked as a major contributor to the ITB Syndrome.
faulty pelvic mechanics.
or stop running (especially hills) until pain has disappeared.
Maintain fitness with cycling, water running, roller-blading or any
other activity that does not increase symptoms.
ice over outside of the knee when pain is severe.
the Glutes and TFL muscles.
–massage over the outside of the thigh, or deep massage of the glutes is
hot tubs or Epsom salt baths to loosen the muscles before stretching.
any potential faulty foot mechanics (pronation), get the right pair of
running shoes for your foot and / or orthotics.
to running gradually. Build up slowly to pre-injury training level. Add