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IT BAND Pain:
How to Recognize and Manage by
By Dyan Quesada MPT, ATC

Recently, tightness of the Iliotibial Band (IT Band) has been publicized, and is frequently said to be a problem in long distance runners. The IT Band, however, has been studied in depth since the fifteenth century. Interestingly enough, Ober determined that a contracture (severe tightness) of the IT Band and surrounding muscles was often the cause of low back pain, because it altered pelvic levels, and placed increased stress on the sciatic nerve. When he surgically released the contracted tissue, relief of the sciatica was seen within 5 - 10 days post-surgically.

The IT Band is a long, non-elastic structure on the outside of the thigh, that crosses both the hip and knee (see picture.) Two muscles at the top of the hip, the tensor fascia lata and gluteus maximus, both blend into the IT Band. As the band descends down the thigh, some fibers attach to the thigh bone (femur), the knee cap (patella), and finally, the top of the shin bone (Gerdy’s Tubercle.)

Various populations may be susceptible to IT Band tightness. Runners, specifically long distance runners, place enormous loads on their bodies, thus placing great demands on the legs to absorb these loads. If one or more of the following conditions are present, excessive force is placed on the IT Band: 1) running in worn shoes, 2) changing your training program too quickly and drastically to include greater speed, and hill training, 3) not maintaining proper strength in the muscles of the knees and hips, and 4) having the pre-existing joint structure of genu varus (bowed legs.) Runners that suffer from IT Band tightness can predict, like clockwork, that after a certain amount of time into their training, severe pain will occur. If training is continued without correcting the problem, this condition can be quite debilitating.

In adolescent females that have complaints of knee pain (patellofemoral and dislocations), tightness of the IT Band may be the causative factor. In the pediatric patient, during a growth spurt, bone growth often occurs quicker than muscle growth. This can leave a tight IT Band. These are often the children who are tall and lanky. Finally, those with cerebral palsy, muscular dystrophy, or polio often have tight IT Bands because they have altered muscle tone.

The signs and symptoms of IT Band tightness can include one or more of the following: 1) pain at the hip bone with or without a snapping sensation during ambulation, 2) pain and tenderness at Gerdy’s Tubercle (see picture), 3) knee "giving out", 4) increased pain in the hip and/or knee when climbing stairs, 5) relief from pain when just standing or sitting, 6) muscle weakness in the hips, and 7) tightness in the hip flexors. When going to a doctor or a physical therapist, there is a specific, simple test that should be performed to rule out IT Band tightness.

To manage IT Band tightness, the specific activity that brings on the pain should be discontinued until the doctor or physical therapist "clears the patient." Several cross training options are available in the interim (swimming, walking, cycling, and various cardiovascular machines.) Ice, anti-inflammatory medications, and physical therapy modalities should be used initially to reduce pain. Physical therapy modalities can include iontophoresis, ultrasound, and electrical stimulation. Once the acute symptoms are managed, the goals are to increase range of motion and strength in the hip. It has been the author’s experience to warm the tissue of the IT Band (using heat and ultrasound), and then perform a friction massage to the length of the IT Band to break up any adhesions (scar tissue.) The patient is given a set of specific stretches and strengthening exercises that they require, based on their evaluation. The IT Band itself is extremely difficult to stretch, and the stretching program usually focuses on all of the muscles that surround the IT Band. Once the patient is without symptoms and has sufficient range of motion and strength in their hips (2 - 8 weeks), they are able to resume their previous activity. It is strongly advised to continue with the stretching and strengthening program after the rehabilitation is completed.

References

Gose, John C, and Schweizer

Netter, Frank H. Atlas of Human Anatomy. Ciba-Geigy Corporation, West Caldwell, 1989.

Wadsworth, Carolyn T. Manual Examination and Treatment of the Spine and

Extremities. Williams and Wilkins, Baltimore, 1988.

Watkins, Andrea and Clarkson, Priscilla M. Dancing Longer Dancing Stronger. Princeton Book Company, Princeton, 1990.


Lateral view-Left leg


a. iliac crest
b. superior rim of acetabulum
c. linea aspera
d. lateral tibial tubercle or
    Gerdy's tubercle
1. tensor fascia lata
2. gluteus maximus fascia
3. lateral retinaculum
4. I.T.tract
5. patella

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