If you have pain on the outside of your knee and leg, you may be suffering from ITBS / Iliotibial band syndrome and this one is for you. If you are foam rolling the outside of your knee then I’ll show you why its better to stop doing that.
What is ITBS
The IT band / Iliotibial band is a thick tissue that runs from the outside of your knee along the outside of your upper leg towards to outside of your hip.
Iliotibial Band Syndrome / ITBS is a localized sharp pain on the lateral outside of the knee. It is usually found in sports and activities where a repetitive action occurs. Running, cycling and swimming are great examples where thousands of the same repetition is repeated.
How do you know if your pain is ITB related?
Although there is some evidence that adductor weaknesses contribute to ITBS there are also stronger evidence that shows that there are foot, knee and hip mechanics and kinetic differences in runners, cyclists and swimmers who have this condition compared to others who do not have this syndrome. So, to be sure let us test and be sure that you in fact have ITBS.
We can do a simple tests right where you are sitting and reading this to determine if your side knee pain is in fact ITB related and not something else.
Check out this video to see the Renne test. We are flexing the effected knee 30-40 degrees and mimic the same pain you experience when training.
Renne Test
If you experience the same sharp pain on the side of the knee, then its confirmed that you have a degree of ITBS.
What causes ITBS
There are mainly 3 scenarios believed to lead to ITBS.
- The first is the compression of a fat pad between the band and the knee itself. Due to repetitive action this pad becomes compressed and leads to the sharp pain. This compression is the reason why you should not foam roll the lateral side of the knee but rather focus on stretching the 3 muscles that tie into the ITBand at the hip. If you normally have tight quads, then you will be more prevalent to this condition. The tensor fasciae latae (TFL) and glutes group need to be addressed.
2. The second scenario is the band gliding or rubbing over the lateral bump of the knee. When you are standing upright the band is in front of the bump / condyle. When you are bending your knee at 30 degrees the band is on top of the condyle (boney thing on the side of the knee) and glides over the condyle when you pass the 30-degree flexion angle. It is believed that this repetitive gliding causes friction in the band itself when the 3 main muscles that feed into the band at the hip are tight and need stretching.
3. Thirdly is an inflamed knee bursa. The bursa is a fluid-filled sac that normally helps the IT band glide smoothly over your knee as you bend and straighten your leg. But if your IT band is too tight, bending your knee creates friction, and a lot of it. Your IT band and the bursa can both start to swell, which leads to the pain of IT band syndrome. Imagine the pain and irritation of an inflamed bursa gliding over a hard knee bump thousands of times while running, swimming or cycling.
All of the above scenarios result in pain and inflammation due to the tightness of the muscles that feed into the ITband. These 3 muscles are glute maximus, glute medius and Tensor Fascia Lata (TFL) located on the front, side and back of the hip. If these 3 muscles are stretched and lengthened to relax slightly the band will have a less dramatic effect when gliding over the later knee condyle.
How to fix ITBS
The first step is to eliminate the stressors causing this pain and irritation – I’m going to use runners and joggers as an example as these are perfect activities that explain the repetitive action and lifestyle that lead to ITBS. If you are not a runner then there are a few lessons and changes we can learn from runners that you can incorporate.
As a runner your first step is to stop running until the syndrome has been corrected. But no runner has ever listened to that advise so instead you need to change a few things. If you only feel this pain after you have recently increased your distance, then you should lower the distance again. Steer away from any downhill running that increases the load on this area. Change the route you run as to prevent repetitive load on one side of the body. Changing your shoes is also a step towards changing repetitive lifestyle that have been proven to work. But the main issue is lengthening those 3 muscles along with the ITB.
Here are several stretches and glute activation exercises to stretch the muscles that feed into the hips and also activate the gluteus to assist with proper training technique in repetitive sports.
- ITB wall stretch – for stretching the ITBand. You want to lean with all your weight onto a wall and lengthen the ITBand. Hold for 60 seconds per leg.
- Glute roll – to relax some tension the gluteus is placing on the ITBand. Expose the glutes by lifting one leg across the other one. Lean onto the side of the glute and roll each leg for at least 60 seconds.
- TFL roll – to relax some tension the TFL is placing on the ITBand. Focus on rolling on top of the hip bone and slightly to the side. This is where the TFL lies and we want to roll this area to release tightness running through the ITBand. Roll 60 seconds per leg.
- ITBand roll – for loosening that ITBand. The ITBand runs from the outside of the knee along the side of the upper leg towards the side of the hip. The common mistake is that people roll the side of the knee and apply additional pressure on an already compressed fat pad, so best to roll the side of the upper leg towards the hip and not on the knee itself. Roll 60 seconds per leg.
- Figure 4 stretch – For stretching the glute group. On your back place the effected leg over the knee and pull towards the chest. You’ll experience an even more effective stretch by pushing your knee away from you. Hold for 60 seconds.
- Cross stretch – For stretching the gluteus and ITBand. Keep your shoulders down and bring your knee across and try to touch the floor. Hold for 60 seconds.
- Side plank clams – for glute activation and stabilizing the hip muscles. Complete 10 reps and hold each rep for 5 seconds. Focus on lifting the leg through your gluteus.
- Glute kicks – Also for glute activation and stabilizing the hip muscles, complete 10 reps per leg. Be sure to kick up towards the side as high as possible, and actively contract the gluteus when kicking backwards.
In part 4 we will examine osteo arthritis in the knee. If you are having / know someone who has issues with straightening the knee or have limited range of motion, then this one is for you. OA is different to the other 3 conditions we have examined as most individuals suffering from this is typically of an older population. Manual therapy and exercises do work but a change in health, diet and lifestyle plays a large roll in this one.
Click here if you are frustrated with repetitive knee issues and are keen to join our tried and tested 12-week Body Transformation and rehab program.
Hannes puts the ‘personal’ back in personal training with dance moves to keep people entertained and a very hands on approach via conducting rehabilitation, sports specific conditioning and functional wellness training. He hosts wellness talks, seminars and writes exercise science courses and workshops. Hannes has qualified well over 1000 new and upcoming trainers and coaches through accredited course providers.
