Iliotibial band pain or syndrome (ITBS) is one of the most common sources of knee pain, especially in individuals involved in endurance sports. It accounts for up to 12% of running injuries and up to 24% of cycling injuries.
IT Band (iliotibial band) is the tightest structure among superficial connective tissue in human body. It stabilizes knee joint placed in the outside of knee joint as an opposing force of hip adductor and internal rotators.
IT Band gets tighter and stiffer with accumulated Scar Tissues or Adhesion after doing repetitive movement. The adhesion between quadriceps and IT Band can prevent natural gliding movement while moving the knee joint, resulting in pain and functional impairment.
Why the scar tissues and adhesion increase?
Every muscle gets bigger and stronger while healing from micro tears in the muscle fibers after continuous movement. In this process, if the waste product such as lactic acid is not dissolved into the blood stream with proper stretching or massage, the tissue creates tight and tender knots in the muscles. With these scar tissues and adhesion, muscle can not activate effectively with increased pain and stiffness.
Signs and Symptoms
- Stabbing or stinging pain along the outside or inside of the knee
- A feeling of the ITB “snapping” over the knee as it bends and straightens
- Swelling near the outside or inside of your knee
- Occasionally, tightness and pain at the outside of the hip
- Continuous pain following activity, particularly with walking, climbing, or descending stairs
How ITB tightness can cause the knee pain?
IT Band is transmitting tension between your hip, knee and the upper part of your lower leg. If this band gets tight and does not glide well with quadriceps muscle, it will pull the patella bone and rotate the lower leg outward. With this abnormal tension, the patella bone is tracking slightly outside of the groove resulting in pain in outside or inside of knee.
What is the most effective way of releasing the IT Band?
The most important aspect in IT Band pain treatment is to decrease tension in ITB by releasing the scar tissue and adhesion. It requires strong external force to achieve this goal due to the nature of IT Band. General stretching has only slight releasing effect and it is not enough to break up the scar tissue. Moreover, we need to consider treatment in Gluteus Medius, Quadratus Lumborum, Tibialis anterior and peroneal muscles which is on the same fascial line (Lateral Fascia Line).
1. Extracorporeal shock wave therapy (ESWT)
By increasing circulation and breaking down scar tissue, shockwave therapy will stimulate cell regeneration and promote normal healing and rapid reduction of pain
2. Vibrocurssor Therapy
High frequency Vibratory force can break up the scar tissue and adhesion with improving circulation. This can be applied by the medical professionals.
3. Trigger Point Therapy with elbow
This technique works amazingly well if the practitioner can pinpoint the trigger point and wait enough until release.
Put one towel on the IT Band and apply the your (practitioner) body weight gently over the tender spot.
Maintain proper amount of force on the spot (Muscle will be twitching if you pinpoint the right spot).
Wait until the tissue becomes softer and move to the next spot.
4. Foam roller stretching
Apply your body weight on the form roller. If you find a tender spot, stay there 30 seconds to 1 minutes and rub it again. Repeated several times in a day.
5. Trigger point release with a firm ball
This can be done as a self trigger point release method. Put your body weight on the firm ball (Lacrosse ball or Yoga tuneup ball). Find the tender spot and stay there for 30 secs to 1 minutes. Try several repetitions in one spot.
6. iliotibial Band stretching
ITB stretching is working better after breaking up the scar tissues, trigger points and adhesion with the above method.
How to prevent ITB pain?
After doing intensive exercise, we must do ITB stretching, form roller stretching or regular self trigger point release with a ball. Also, we need to strengthen our muscles around ankle, knee and hips for improving endurance while doing exercise.
Don’t forget to do stretching the muscles you have used since the waste product after using your muscle will build up and it will increase annoying scar tissues and trigger points progressively.