Iliotibial Band (IT Band) Syndrome is a common problem, especially among athletes and weekend warriors who participate in sports with repetitive knee (and to a lesser extent, hip) bending, such as running and cycling. This pain at the outside part of the knee (and to a lesser extent, hip) is commonly caused by repetitive friction from something called the Iliotibial Band (IT Band).
The IT Band is a large band of connective tissue that forms from deep connective tissue of the hip, as well as attachments of the gluteus maximus and tensor fasciae latae muscles. The band inserts on the lateral aspect of the knee. Its primary action is to stabilize the hip and knee. When problems with the IT band occur, you may experience lateral knee pain especially when going up and down stairs or hills, a snapping sensation in the hip, bursitis at the hip or knee, inappropriate tracking of the patella (knee cap) leading to pain or a grinding, cracking or crunching when flexing the knee, or many complain of symptoms when rising from sitting or lowering to sitting.
To prevent and manage IT Band Syndrome, it is essential to maintain flexibility and strength in the lower body specifically in the low back, hips, knees, and leg muscles. For example tight gluteal or hip external rotators like the piriformis cause tension on the IT band by causing the leg to externally rotate.
How to Manage IT Band Syndrome
On the other hand, if the gluteal muscles are weak or inactive due to tight hamstrings, a faulty gait pattern could be present, causing compensatory muscles from the low back to inappropriately take over. This potentially leads to different strains to the IT band, as well as a myriad of other movement faults that are beyond the scope of this article.
A combination of strength (muscle endurance), stability and flexibility of structures that work synergically around a joint, are needed to optimize function. Due to the close symbiotic relationship between the IT band and the hip Abductors/Adductors, weakness in these muscles can compromise stability, biomechanics and flexibility. If clinically recommended, endurance exercises can strengthen the muscles that help bring the leg out to the side away from the body and back in towards the body (hip abductors and adductors) might be beneficial.
This list is not comprehensive but should be part of a balanced exercise routine that includes stabilization/endurance, cardiovascular, flexibility, and core strength, and as always, it’s always best to see a health care provider before beginning prescriptive exercises.
IT Band: A tight IT band is a compensatory response to instability in the pelvis or knee
Hip External Rotators
Side-lying Leg Lift (Hip Abduction)
Poor stabilization of the pelvis from weak gluteus medius will cause the body to recruit the TFL as a secondary stabilizer. One of the most common exercises prescribed to target the gluteus medius is leg abduction. This exercise can be done without a resistance band to begin and progresses over time to include a resistance band to increase the difficulty.
For this exercise, begin by lying on your side. It may be necessary to place a pillow under the head to support a neutral spinal posture. Slightly bend the bottom leg to help stabilize the body. As your skill level improves, you can straighten the bottom leg causing an increased need to recruit core muscles to stabilize the body. Keeping the top leg straight and in a neutral position, slowly raise it towards the ceiling while exhalling. At the top of the movement, bring the leg back to the floor in a slow and controlled manner while inhaling. Repeat this movement between 10-15 repetitions before switching to the opposite leg.
Externally rotating the femur (leg). If you find that you are having trouble not externally rotating the leg, this can be due to the body trying to compensate for weak abductors. If this is the case, first focus on stretching the muscles listed above and second, begin this exercise in a standing position (described below) until you feel comfortable with the movement pattern. Remember, it is faulty movement patterns that cause this problem in the first place, so doing these exercises wrong is counterproductive. We always focus on perfect form first.
Standing Resisted Hip Abduction
This exercise is a progression from the side lying hip abduction when done with resistance, due to the increased demand for stabilization of the body, but can also be a beginning exercise when learning the proper technique for the side lying abduction. The latter is simply done without resistance, holding on to a stable anchor, like a chair on the non-moving leg and finally, to be done in front of a mirror to watch for external rotation of the leg, hip hiking or pelvis rotation.
When progressing from the side lying abduction, this exercise will help you practice balance and stability of the hip and knee on the supporting leg while strengthen the exercising leg.
Stand near a wall or have a chair close by to help stabilize. Begin by lifting one leg slightly off the ground and moving your leg to the side, then bringing it slowly back in. This exercise is important to keep the hips level and the torso in an upright and engaged position. Adding resistance bands to your ankles will increase the difficulty of this exercise.
Banded Lying Bridge
The bridge exercise is excellent for what we call neuromuscular reeducation, in this case, of the gluteal muscle group. As discussed above, when a muscle becomes tight, it can turn off a synergistic muscle. In this case, tight hamstrings can cause the gluts to turn off. In addition to strengthening the glut group, this exercise is designed to reeducate the nervous system to engage the muscles when needed. Therefore, this exercise has far reaching benefits beyond ITB syndrome.
This exercise begins by placing an appropriately sized resistance band around the knees, ensuring the skin is not pinched. Lie on your back with your knees bent. Push your hips up to the ceiling while gently keep tension at the knees by abduction. Slowly return to the starting position and repeat 10-15 times. Be sure to engage your core throughout the exercise. You do this by contracting your Transverse abdominus and Multifidi muscles. Remember is to keep your pelvis neutral throughout this exercise.
This exercise targets the abductor muscles, essential for pelvic stability, on the supporting leg and the quadratus lumborum muscle (a low back muscle) on the opposite leg, critical muscles for walking.
To begin this exercise, find a small step or short stool to use. For beginners, you can hold on to a chair for stability but you should be working towards relying solely on the body for stabilization. Standing sideways on the stair, make sure your core is engaged and your hips are level. Keeping both legs straight, stabilize one leg on the step and allow the other to slowly drop towards the ground below the step. Slowly and with control, hike your hip back up to the starting position. Repeat 10-15 times before switching to the other side!
Begin standing with soft knees and your feet hip-width apart and parallel. Hold a kettlebell, a barbell or two dumbbells in your hands down in front of you. Engage your core and shift your weight onto one leg.slowly start hinging at the waist, tipping your torso forward until it’s almost parallel to the floor while simultaneously raise your non-weight bearing leg behind you. Your arms should be hanging straight down, holding onto the weight. Slowly bring back your extended leg and return to starting position. Repeat 10-15 times and then switch to the other leg. While performing this exercise it is important to maintain a neutral and level hip position and complete the movement with control.
Banded Monster Walks
Once you have progressed through the above exercises that focus on balance and stabilization, you can progress to functional strength-focused exercises. The banded monster walk allows you to train the muscles attached to the IT band in a movement-based way.
To begin this exercise, place an appropriately sized resistance band around the knees. Stand with the core engaged, hips slightly wider than shoulder-width, and toes forward. Bend into the beginning of a squat, stopping about in about a quarter of a squat position. Keeping your weight in the middle of your foot and maintaining the slight squat, take some small steps sideways, being sure to maintain tension on the resistance band throughout the movement and push out with your knees. Take about 10 steps in one direction, then take some small steps back in the other direction. As with many of the exercises mentioned above, it is important to perform this motion slow and controlled!
Conservative Care First
IT band syndrome is almost always due to a breakdown in proper biomechanics. Cause of IT band syndrome varies from patient to patient, therefore it is important to find out if the inappropriate stresses due to compensatory movement patterns can be corrected and the symptoms eliminated. Research suggests that conservative care, when applied correctly, has a 90% success rate. If you do not get relief of your symptoms from the above exercises, seek out a qualified health care professional trained in assessing proper biomechanics. Other causes not addressed in this article that deserve investigation include lateral rotation fixation of the tibia, excessive foot pronation, weak or loss contraction of vastus medialus oblique, subluxation to the nerve supply at L4 and/or L5 .