1. Gator Country Black Friday special!

    Stay on top of the football coach search with the Insider Authority on Gator Sports with a special discount!

    Now's a great time to join or renew and get up to $20 off your annual subscription! LIMITED QUANTITIES -- for details click here.

Iliotibial Band Syndrome questions ...

Discussion in 'Gator Country Health and Fitness' started by Dreamliner, Dec 5, 2011.

  1. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    For any of you in the know, pain on the outside of the knee. I see it fairly frequently. The reason I'm throwing this out for discussion is because the usual treatment strategies are being called into question:

    *Foam-roll the bejabbers out of the little monkey: but the ITB is stronger than a tractor tire.

    *Stretch the damn thing: but the ITB is stronger than a tractor tire and may actually be less relevant biomechanically than other structures.

    Are the glutes typically a major player here ? Is the medial glute THE major player ?

    Thoughts ? Observations ? Waddaya got for me ?
  2. LeafUF
    Online

    LeafUF Well-Known Member

    Joined:
    May 1, 2007
    Messages:
    13,464
    Likes Received:
    298
    Trophy Points:
    83
    Location:
    Wandering
    Ratings Received:
    +364
    I have little knowledge of this other than knowing two people who have had issues with theirs. One was training for a marathon and the other just worked on her feet all day. I think both of them did a lot of foam roller and used the theracane. Theracane is awesome by the way.
  3. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    Thanks, Leaf. It certainly does seem to be a common complaint among runners. Fortunately for them - and unfortunate for me - medial knee pain is dicier.
  4. LoyalGatorFan
    Offline

    LoyalGatorFan Active Member

    Joined:
    Apr 3, 2007
    Messages:
    1,643
    Likes Received:
    14
    Trophy Points:
    38
    Ratings Received:
    +30
    Well let me start out by saying the ultimate solution to any lower extremity and spinal injury is to stop running....running is terrible for you in terms of the musculoskeletal system....each time your foot hits when running you send a GRF (Ground Reaction Force) up the kinetic chain of the body...and over time it just wears out your knees, hams, calves, feet, lower back, etc....in an ideal world I would tell everyone to do cardio with machines (tread, elliptical, bike,etc) but I know thats not going to happen...

    Anyway with the OP, you do wanna stretch the ITB actively because not only can it cause ITB syndrome if it's tight, it can also lead to PFPS (patellafemoral pain syndrome)...what happens with PFPS is the ITB pulls the patella (kneecap) outwards and gets the patella out of its groove in the joint...thus causing irritation on the underside of the patella...think of a train being off the tracks...its gonna grind and grind until it wears out the brakes/rails/etc....this is called chondromalacia....

    As far as the foam roller, I did not realize it is being called into question...I know a number of physical therapists who have their patients perform this exercise...i liken it to a combination of a ITB stretch and massage....it helps to break up the tight muscle fibers....

    And yes the glutes are a major player...your glutes along with your piriformis (the muscle that can cause sciatica) are external rotators of the hip...meaning if they are tight they are going to cause the whole leg to turn outwardly thus making the ITB tighten...conversely if the internal rotators of the hip are tight, its gonna cause the leg to turn inward and put the ITB on stretch....so Dreamliner yes your glutes are a major player in preventing and treating ITB syndrome...make sure you have the patients with ITB stretch the glutes....to be more specific I would say the piriformis and gluteus medius are the two biggies....
  5. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    Thanks for the feedback. I suspect that you're on the money on the glutes. The recent reservations arise from the nature of the ITB - it's unbelievably tough. In any case, the two runners I'm working with are WEAK in the lower body. They find bodyweight squats and lunges challenging. One had come to me for an upper-body program "because their lower-body was already strong from running." I told her, "no, it's not." :laugh:
  6. LoyalGatorFan
    Offline

    LoyalGatorFan Active Member

    Joined:
    Apr 3, 2007
    Messages:
    1,643
    Likes Received:
    14
    Trophy Points:
    38
    Ratings Received:
    +30
    Hahaha thats awesome..I love the blunt honesty...yeah lower body strengthening is also important because it can help compensate for a weak/injured ITB...although just be careful having them do those exercises if they are already experiencing pain with the ITB...but yeah the ITB is hard to describe...not many people know how to describe it...its not really a muscle but acts like one...i just called it a band of soft tissue....and yeah the ITB is very hard because its so fibrous....and throughout the day it is constantly being used through walking, sit to stand, stand to sit, etc...
  7. gator70
    Offline

    gator70 Member

    Joined:
    Apr 3, 2007
    Messages:
    206
    Likes Received:
    0
    Trophy Points:
    16
    Ratings Received:
    +0
    I am a triathlete and in 2007 during an Olympic triathlon I started having some ITB problems on the bike. It then worsened on the the run about mile 4 and I hobbled to the finish line. I had only done Sprint tri's to this point.
    I went to an orthopedist who diagnosed it as ITB. He recommended stretching and taking Aleve to prevent the swelling. He did not recommend any surgery and said I was good to go as long as I could take the pain.
    In 2008, I continued training and started using The Stick Roller and using the ITB straps that went around your knees. In 08 I did a Half Ironman and Marathon using this techniqued, but I still had pain throughout the 08 race season. It usually happened after long bike rides (50-60 miles) or long runs (15-20 miles).
    In Feb 2009 I was determined to do an Ironman so I hired a Trainer who had done quite a few Ironmans. I told him about my ITB and my prior history. He laughed at my staps and said he didn't like them. He put me on a regular stretching program, a foam roller, alot of core strenghtening exercises and a lower body weight training program. I continued to take Aleve before training. I ran a Marathon in April 2009 and at mile 20 my ITB swelled up and I limped to the finish line. At my wife's insistance, I did not take Alleve before the race because they are NSAID's and she read they were bad to take before exhaustive exercise...even though I had done all my long runs using Alleve. By September 09 I ran the same Half Ironman and cut 45 minutes off the 08 half Ironman with no ITB pain. In November 09, I completed my first Ironman in 12:17 with no ITB pain and in December 09 I went to Australia and completed my second Ironman with no ITB problems. Since the Marathon in 09, I have been free of ITB problems. I feel the lower body strength training along with the core exercises and stretching helped the most. I still continue to take Alleve every day. Two on long workout days...don't tell my wife.
  8. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    Re: the wife - mum's the word. But that's quite an inspiring story! What kinds of exercises did you do for lower body ? What did you stretch ?
  9. gator70
    Offline

    gator70 Member

    Joined:
    Apr 3, 2007
    Messages:
    206
    Likes Received:
    0
    Trophy Points:
    16
    Ratings Received:
    +0
    Thanks.

    Did mostly leg extension type exercises with not alot of weight. I also used a Pilates ball where I would lay on my back and put my feet on the ball. Keeping stomach tight I would raise my body up and bring the ball towards me with my feet. For my core I lay stomach down with my elbows/arms on the ground and supported my body as long as I could. I would then turn on my side and do for each side. I would do 3 sets of this twice a day.

    For stretching I used a rubber band where I would lay on my back and try to bring my leg back towards my head for a minute. I would then stretch my right leg to the right and hold for a minute. Then I would stretch my right leg to the left across my body for a minute. I would do the same with the left leg. I would do 3 set twice a day.
  10. el_lagarto
    Offline

    el_lagarto Premium Member

    Joined:
    Jun 19, 2008
    Messages:
    3,099
    Likes Received:
    150
    Trophy Points:
    63
    Ratings Received:
    +539
    [​IMG]

    has never failed me. key is pelvic and lumbar spine position so the IT band rides over the greater trochanter which adds a perpendicular force to the tendon causing more of a stretch. jutting the hip out intensifies it.

    ITB stripping is always fun and super painful for the client. not a lot of pain on earth like a thumb or god forbid the point of an elbow running down your thigh right next to a tight inflamed ITB. great for masochists and sadists alike.


    i dont recommend either for anybody with opposable thumbs...or hip replacements.

    consult your doctor before doing anything.
  11. 96Gatorcise
    Offline

    96Gatorcise Well-Known Member

    Joined:
    Aug 6, 2008
    Messages:
    7,251
    Likes Received:
    471
    Trophy Points:
    83
    Location:
    Tampa
    Ratings Received:
    +1,463
    Dream, we have had these discussions before. My experience in dealing with this issue with my clients is increase overall lower body strength. More specifically the VMO and Glut Max and I believe that most ITB pain can be traced back to weak adductors.

    The ITB is used by the body for stabilization. It keeps you from swaying side to side like a dancing girl when propelling yourself forward. The adductors are rarely activated except when pulling your leg inward as in when you get into a car and put one leg in at a time. Over time this weakness causes a bowing inward of the knee and a tracking issue with the patella tendon.

    Summary- strengthen inner thigh and stretch outer thigh, increase glute activation and VMO strength.

    I have found that if the pain is mild incorporating slide board work into a routine really fires off the adductors and can relieve the ITB stress in a matter of weeks.
  12. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    Damn! I knew I shouldn't have thrown out that Cheryl Ladd sliding board my wife and I used years ago! But I must confess that I've been thinking more in terms of a need for a(b)ductor activation than adductor activation. I'll take this under consideration. thankfullly, I don't have ITB. Wish I did as PFPS seems a bit more squirrely in terms of treatment.
  13. LoyalGatorFan
    Offline

    LoyalGatorFan Active Member

    Joined:
    Apr 3, 2007
    Messages:
    1,643
    Likes Received:
    14
    Trophy Points:
    38
    Ratings Received:
    +30
    Dream, it depends how the patella is tracking as to what muscles you want to strengthen vs stretching...if its tracking lateral (which can happen with a tight ITB because the ITB will pull it lateral) then you do want to strengthen VMO and adductors since those are medial muscles to help pull the patella back into the groove and keep it there...its like a tug of war between medial and lateral basically...

    On the contrary, if the patella tracks medial, you want to strengthen lateral and stretch medial.....and just so ya know PFPS is a garbage term...it doesnt always mean patellar tracking issues...it could be chondromalacia (which could however be caused by patellar tracking), it could also be a patellar fracture or dislocation...it stands for patellafemoral pain syndrome which means any type of injury that causes pain in the knee joint can technically be incorporated under that abbreviation....

    Hope this helps...
  14. Dreamliner
    Offline

    Dreamliner Well-Known Member

    Joined:
    Apr 8, 2007
    Messages:
    64,899
    Likes Received:
    365
    Trophy Points:
    83
    Ratings Received:
    +1,759
    Loyal, I'm afraid I'm losing confidence in the more conventional explanations. It seems to me that stretching and/or foam-rolling the ITB would be about as effective as stretching and/or foam-rolling a tractor tire.

    With respect to medial knee pain, why would anyone want to perform a movement (TKE's) that only serve to stress the inflamed area ? Aren't you a chiro ? Aren't you chiros fond of telling your patients "What's hurting is not where you're hurt" ? :wink:

Share This Page