It's just a band!

Whether you’re training for your first marathon, crossing off a few 5k’s for the New Year’s Resolution of 2016 2017 2018, or simply running around town with the kids, you may have knee pain caused by your IT band.

It’s not uncommon for a patient to walk in with what they believe is nagging knee pain from over-use or unknown reasons. The truth is, IT Band Syndrome is one of the most common injuries due to over-use, poor stabilization, and bad coordination.

What is an IT band?

The iliotibial band (IT band) is a tendonous/fibrous sheath of tissue that extends from your hip down to the outside (lateral) portion of your knee. When this band becomes inflamed or overused, it mimics knee pain very closely.

The IT band is the proverbial middle child of the upper thigh. It gets blamed for everything, is rarely the favorite, and is often overlooked. When that middle child is getting beat on, the parent must figure out who is the victim and who is the culprit in the situation.

The same goes for the IT band, although it may be getting hypothetically punched in its face, it is definitely not the culprit. It is the victim. Like I said in the title, it’s just a band. There’s a slim chance that just a band of fibrous tissue could “punch itself in its face.”

As the famous biochemist and creator of Structural Integration stated so eloquently, “where you think it is, it ain’t.”

What she meant here was often we get pain in a specific place (like your lateral knee or IT band) but the problem is actually occurring due to something other than that location.

I’ll explain more on that a little bit later. For now, think about the action of throwing a baseball. Perfect and smooth mechanics throughout your kinetic chain (head to toe) allow you to get the ball from your hand into the catcher’s mitt. Now pretend I told you to throw it by only moving your wrist. Every other joint must stay stable. 

I doubt many of us would be able to get the ball even half way to home plate. And, chances are, we would look pretty dumb while doing so, right? The point is this: ANY complex movement takes the proper coordination of many muscles and tissues to load/unload and to contract/relax, as well as proper eccentric contraction/control of such muscles in order for us to perform that movement optimally.

Now, let’s think back to what Ida Rolf said: if we threw that ball 1,000 times with just our wrist, there will eventually be pain in the wrist. Though it may be true that the pain in the wrist came from the wrist. Duh. But imagine if we threw the ball with the entire body and used our entire kinetic chain with coordinated movements.

I doubt that wrist would be feeling nearly as bad. The same can be said with our IT band. If we allow the other muscles that surround the joint to function at their best, our IT band doesn’t have to take all the stress. “Where you think it is, it ain’t.”

Do me a favor and stand on one leg. You may do whatever you want with your arms to balance, but keep your ‘off-leg’ at 90 degrees. Stay balanced for 10-15 seconds and, if possible, do so in front of a mirror so you can see yourself. Doing pretty good?

Now try closing your eyes while balancing. This simple test shows where our tendencies of our body are. If you’re rotating back and forth to stay stable, or drifting right or left while you’re about to fall over, that displays where your weaknesses are! Think about this: if we have tendencies to drift to our left when we’re balancing, won’t we have a tendency to drift to the left when walking or running? Of course!

Now, if we’re constantly trying to correct our internal tendencies (so we can run/walk straight), thus using effort and energy to do so, isn’t that a waste? Definitely. Of course we don’t just walk a few yards with wasting energy. Anyone with a Fitbit can tell you that we’re supposed to walk 10,000 steps per day. Ten thousand potential steps of wasted energy.

To bring this all back to the test, if we’re lacking stability in the frontal plane (left to right) or transverse plane (rotational), we’re putting a lot of strain and stress on the IT band that can be solved by engaging other muscles.

How do I strengthen my IT band?

Muscles that need to coordinate together in order to stabilize the frontal and transverse plane are:

Quadratus Lumborum (QL) and Internal/External Obliques – The obliques attach from the crest of your pelvis to your ribcage. And while their primary movement, independent of one another, is to stabilize rotation, combined they can laterally flex your trunk.

The QL runs from your iliac crest as well and attaches to the 12th rib and a few of the lumbar vertebrae. Given its attachment points, this muscle plays a huge role in frontal plane stabilization, especially when we are balanced on one leg.

Glute Max / Glute Med / TFL – These muscles, for the most part, comprise our abductor group (as well as partially external rotators of the thigh). The abductors move the thigh away from the midline of the body.

All of these muscles attach themselves to the IT band either directly or via an aponeurosis (basically a wide tendon sheet). The activation of these muscles is important for preventing the knee from deviating inward while we walk/run/cycle/etc.

Vastus Lateralis (VL) – Although its role is minimal, the vastus lateralis runs from the top of the femur and attaches at the common quadriceps muscle location just below the kneecap.

The VL helps by initiating external rotation of the thigh. Oftentimes, due to location of the muscle belly, the VL becomes inflamed and annoyed by IT band symptoms.

Adductor Muscles – The entire group of adductor muscles performs the exact opposite motion of the Glute Max/Glute Med/TFL. The term for this is that the adductor group is the antagonist of the abductor group.

Therefore, this group of muscles have the giant role of ECCENTRICALLY contracting in order to control the motion of the abductors. Eccentric contraction is defined as contraction while lengthening the muscle tissues.

This helps as a braking action for the muscles that are contracting and shortening – in this situation the abductors are the muscles needing the braking.

Clearly, there are quite a few muscles that stabilize these planes of movement! If that wasn’t enough, there are actually other players in the game but this is a good start. All of these must work in sync in order to create an optimal, functional, and high performance movement pattern.

If not, the bad pattern leads to irritation, then inflammation, and eventually chronic pain. The IT bands, and surrounding stabilizers, are not immune to this process. Some of the greatest athletes are great compensators, and when we compensate for bad movement, this is the road we go down.

How To Avoid IT Band Syndrome

If your IT band is legitimately ‘tight’ or has fibrous adhesions within it, by all means a foam roller and stretching are going to help it! Similarly, if there is pain in the lateral knee, caused by your IT band, foam rolling it will make it feel better temporarily.

That being said, unless you take care of the unbalanced and inhibited stabilizing muscles (see the list above) that surround the IT band and control its movement, the pain will most likely come right back with a vengeance.

After all, the IT band is just that. A band of fibrous/tendonous connective tissue that has almost zero ability to lengthen or shorten by any meaningful amount.

The band is essentially a marionette puppet to the muscles that act upon it. Again, unless you confront the CULPRIT, rather than the VICTIM, the pain will keep coming back.

And sure, all these ‘culprit’ muscles may be stronger than Schwarzenegger in his prime. But unless they are strong when they are told to be strong, and relax when they’re told to relax, there will be an issue. Remember, the coordination of the muscles to work with one another is key to yielding a high-performance and functional movement.

At this point you may be asking yourself, “So how the heck do I figure out if any of these surrounding muscles aren’t acting properly?” Great question.

Do we expect you to figure it out yourself? You’re more than welcome to, but you’ll probably end up with a headache. This is what your health practitioners are meant for. They’ve studied this stuff so extensively that picking out the poor movement coordination is second-nature to them.

Here at Minnesota Movement, all of our providers have an almost annoying passion about this stuff. Figuring out all the variables of proper movement is what we specialize in analyzing and treating.

Contact us and see how we can empower you to get better, feel better, stay better, and perform better with chiropractic care and wellness programs!

- Dr. Reid Nelles