In the past few years I have encountered a lot of athletes with the same story. “Doc my knee hurts right here on the outside of my knee. I think I am getting arthritis or something.” Most of the time they are a serious runner, biker, or triathlete working hard in their sport. The truth is there is much more to the situation than meets the eye. The ITB or iliotibial band by definition is “a longitudinal fibrous reinforcement of the fascia lata. It is attached to the anterolateral iliac tubercle portion of the external lip of the iliac crest and to the lateral condyle of the tibia” (wikipedia). Put a little more simply it is a piece of strong connective tissue that runs from the hip bone down to the outside knee bone. The real purpose of that tissue is to support the knee in different positions. As the knee is extended, it helps support the front of the knee joint. As the knee bends past 30 degrees it supports the back of the knee joint as a stabilizer. Now because the knee is constantly moving through this range of motion with sports the irritation begins to build over the knee bone or femur and pain is felt. Now for the curve ball. What is causing the tightening of the ITB?
Because the ITB is just a connective tissue and is not a muscle it cannot be the culprit in tightening. Through research and experience, I have found the ITB is tightened for a few different reasons. First I always look to the pelvis and alignment. When the pelvis is rotated, the pelvic bones are not able to move correctly. This will cause a shorter leg on one side or abnormal motion of the hip. As the joint continues to be restricted, the associated or attaching muscle will start to spasm and tightness occurs. Usually alignment of the pelvis with an adjustment, hip stability exercise and myofascial release of the legs and gluts will get the knee feeling brand new.
The second way is over development or overworking of the quad and/or hamstring. This is usually found during over training and running uphill/downhill. When the muscles are overworked and pumped up during a hard workout, they can start to press on the ITB. Combine this with a constant rubbing of the ITB over the bone in the femur and you now have knee pain. This is where daily foam rolling really helps keep that inflammation and tightness out of the legs.
I am only putting two reasons on this post because they are among the most common. There are a list of less common reasons including child bearing, weight gain, foot pronation, bowing legs, etc.
If you are having this pain, don’t wait for it to just go away. Over time this irritation can become worse and it is important to attack the issue sooner than later.
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