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Overcoming IT Band Syndrome of the Knee

Iliotibial band syndrome may be diagnosed when there is pain at the outside part of the knee. The iliotibial band, often referred to as the "IT band" is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee.

Symptoms of IT Band syndrome include:

  • Stabbing or stinging pain along the outside of the knee
  • A feeling of the ITB “snapping” over the knee as it bends and straightens
  • Swelling near the outside of your knee
  • Occasionally, tightness and pain at the outside of the hip
  • Continuous pain following activity

If you have IT Band syndrome, it could be due to movement compensations.  Factors that lead to movement compensations include poor mobility of the hips and ankles.  You may also have weakness of the hip, thigh, and calf muscles.  In addition, if you have difficulty creating stability at your core, you may be further compensating when you run, walk, or perform squatting and lunging movements.  This could mean increased pain and tightness following bouts of exercise.  The best way to know what is contributing to pain and injury is to have a movement assessment performed.  Although the causes of IT Band syndrome are varied, there are basic principles that should help you overcome IT Band syndrome.

If the outside of your knee is irritated and painful, the first common-sense recommendation is to take a short break from the activity that aggravates your knee further.  This may mean taking a break from running, squatting, or other lower body exercises.  Taking a break should allow for pain and irritation to subside.  If your pain persists, receiving hands-on therapy can be effective to help your pain subside more quickly.  Soft tissue mobilization of the outer thigh and lower leg muscles and joint mobilization of the knee cap, thigh, and shin bones can have a profound effect on pain intensity.

Once your pain is under control, you can now address the root causes of why you're experiencing knee pain when performing step-ups.  If you have weaknesses, learning how to activate muscles that are not firing well is key.  Sometimes the outer hip (gluteus medius) muscles or posterior chain (glutes, hamstrings, and calf muscles) are not be strong enough to power walking or running stride.  Or, they may not engage to maintain tension when performing squats, lunges, or step-ups.  If this is the case, your TFL could overwork and tighten up the IT band and result in knee pain. Exercises that tend to be good places for most people start include the side-lying straight leg raise, bridge with adduction, and quad set.

Once your muscles engage better, you must restore normal movement of your hips, knees, and ankles.  Your hip must rotate enough to assume a stride position without compensating. "90/90  hip internal rotation" is a great exercise to work on hip mobility. Your toes and ankles need to bend enough to maintain a stable foot when pushing off the ground.  Single-leg calf raises off a step can help you develop calf, foot, and ankle mobility.  It is important to remember to load your big toe when coming to the top of the calf raise.  When you descend to the bottom of the calf raise, you should "pull" with your shin muscles to train your calf's total range of motion.

After you have restored movement, you need to develop strength in single-leg patterns of movement.  This will enable you to prevent the reoccurrence of pain when you get back into walking, running, and lower body exercises.  Exercises that are helpful in building strength in single-leg patterns include the single-leg deadlift, step-up, rear foot elevated split squat, and single-leg squat.  Resistance can be used in the forms of barbells, dumbbells, or kettlebells.  Being able to generate tension through your hip, thigh, and foot muscles when standing on one leg is key to keeping your knee healthy and enjoying an active life.

Most of the exercises mentioned above can be found in our video library.

When addressed with a specialized physical therapy program, overcoming IT Band syndrome is possible.  However, ignoring pain and engaging in repetitive activity can result in a further decline of your knee health.  If you're worried about your knee pain, the physical therapists at Movement Solutions would be glad to help you.

We invite you to request a knee consultation with one of our specialists.  This is an opportunity to ask questions, obtain clarity about your knee pain, and foster confidence that we can help you.  If you’re certain that we’re a good fit to work together, you can decide on the next step.

If you’re in knee pain but unsure about what you should do, call us at (864) 558-7346 and ask how we can help.

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