Have you been noticing pain on the outside of your knee, hip, or thigh without a known injury? If your answer is Yes, then you may be experiencing symptoms of Iliotibial Band Syndrome. Iliotibial Band Syndrome (IT Band Syndrome) presents as pain along the outside of the thigh from the hip to the knee.
Beyond the pain and discomfort, you may also hear audible snaps as the tissue frictions over the outer edge of the thigh bone. Your IT Band is a strong, thick, fibrous band of tissue that runs down the outside of your thigh. As you can see in the illustration below it extends all the way from your hip bone to the top of your shinbone as it melds with the musculature of your hip and thigh to assist with stabilizing both areas during movement.
With repeated bending and straightening movements of the knee, the IT Band may friction and irritate surrounding tissues, causing pain. It is most common for people who often perform the repetitive motion, especially distance runners, cyclists, or new recreational athletes.
Your physical therapist will be able to identify whether your pain is a result of IT Band Syndrome or another problem based on your symptoms as well as a physical examination assessing your strength, flexibility, gait pattern, and quality of movement.
Once your concerns are identified as IT Band Syndrome, you and your physical therapist will design a customized plan of care to address your imbalances and movement dysfunction.
The IT Band runs down outside of the thigh from the hip to just below the side of the knee. The iliotibial band (ITB, IT Band) or iliotibial tract is a reinforced band of dense fibrous connective tissue/ fascia in the thigh connecting proximally to the Tensor Fascia Lata and Gluteus Maximus muscles, and distally to the lateral condyle of the tibia ( Gerdy’s Tubercle).
Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats).
IT Band Massage: ITBS SIGNS & SYMPTOMS
- Pain is gradual at onset and worse with activity
- Pain felt at lateral thigh and lateral knee
- Thickening, adhesions and fibrotic nodules ( like adhesions along the fascia) of the affected IT Band ( especially in the knee area where theres a lot of movement)
- Hypertonicity and Trigger points in the Tensor Fascia Lata, gluteus maximus, hip flexors, rectus femoris leading to decrease circulation and shortening of these muscles
- Inflammation at the lateral femoral condyle due to tight IT Band. There could be rubbing and inflammation at the hip due to trochanteric bursitis
- With anterior pelvic tilt, lumbar pain, and SI joint hypermobility
- Valgus or hyperextension at the affected knee
- Pes planus
Iliotibial Band Contracture & IT Band Friction Syndrome
- ITB Friction Syndrome is inflammation and pain where the IT band crosses the lateral femoral condyle
- ITB contracture is the shortening or thickening of the IT band
- ITB Contracture and Friction Syndrome may occur unilaterally or bilaterally
- The fascia surrounding Glute Max and Tensor Fascia Lata (TFL) join to form the IT band
- IT band provides lateral support to the knee
- When fascia is contractured, biomechanics of the knee and hip are restricted. Ankle and SI joint may compensate
- Bursa between the greater trochanter and IT band may become inflamed ( trochanteric bursitis)
- Trigger points in glute max and TFL may also contribute to ITB tightness
IT Band Massage: CAUSES of IT Band Syndrome / IT Band Contracture
IT Band Friction Syndrome
- Prolonged, repetitive activities where knee and hip are flexed – like running, cycling
- Contributing factor – poor TFL stretching procedures, anterior pelvic tilt, tight TFL, glutes
- Activities or occupations that place the knee and hip in flexion (cycling, horseback riding, prolonged sitting, running with pronated feet) and allows ITB and TFL to tightened
- Postural Imbalance – anterior pelvic tilt/hyperlordosis
- Prolonged wheelchair use, bed rest
IT Band Massage: OBSERVATION
- Hypertonic IT Band creates an indentation in the lateral thigh
- Unilateral IT Band contracture, lateral pelvic tilt can be seen on the affected side
- The affected knee is valgus
- Pes planus on the affected side
- With bilateral IT Band contracture, anterior pelvic tilt due to short ITB and TFL
- Hyperlordosis from anterior pelvic tilt, short hip flexors, rectus femoris
- IT Band friction syndrome may show redness, edema at affected lateral femoral condyle
- Lateral quads and hamstrings may be tight
IT Band Massage: PALPATION
- Tenderness along with IT Band, especially distal 1/3, also at the greater trochanter
- Affected IT Band thickened, adhesion present
- On the affected side – hypertonicity and trigger points in the TFL and glute max.
- On non – affected side – hypertonicity and trigger points in the hip flexors
- If bilateral, hypertonicity and trigger points in TFL, glute max, rectus femoris, iliopsoas, adductors, and Quadratus Lumborum
- With friction syndrome, inflammation, heat, swelling, point tenderness local to the lateral femoral condyle area
IT Band Massage: ROM TESTING
- Active Free ROM of the affected knee, hip, SI joint, and Lumbar Spine
- Reduced extension and adduction of the hip
- Painful knee extension with friction syndrome ( esp. in the act of extending the knee – tight band snaps to the lateral femoral condyle)
- Passive Relaxed ROM of the affected knee, hip, SI joint
- Painful at the lateral knee with extension
- Active Resisted testing of TFL, rectus femoris, glute max, glute medius, iliopsoas, Quadratus Lumborum
IT Band Massage: SPECIAL Orthopedic TESTING
- Thomas Test – tight ITB, TFL, rectus femoris
- Ely’s Test – right rectus femoris
- Ober’s and Modified Obers – tight ITB, TFL
- Noble’s Test
IT Band Massage Therapy Treatment
- Fascial Techniques to ITB, in various directions and interspersed with effleurage ( to drain and because fascial work there is painful)
- Skin rolling, Cross-hand spreading, C and S bowing techniques, J stroke
- Cross fiber friction to adhesions, followed by ice and stretch
- If friction syndrome is present, inflammation at lateral femoral condyle makes onsite fascial technique impossible. Use ice locally. Working on the proximal IT Band can reduce tightness in the distal IT Band until the inflammation is gone and on-site work is possible.
- TFL muscle massage: treat hypertonicity, adhesion, trigger points by ( skin rolling, petrissage, stripping to the attachment at the iliac crest and around trochanter, GTO at trochanter where TFL distal musculotendinous junction located)
- Glute max: massage for hypertonicity and trigger points
- Repetitive effleurage to lateral leg and glutes to increase circulation
- Contrast hydro can improve circulation
- Rest of affected leg: treat iliopsoas, quads, hamstrings, adductors, muscles of the lower leg
- Passive Relaxed ROM of hip and knee. Ankle, knee, hip, SI joint treatment with joint play itb massage, massage for its band, it band massage therapy, massage therapy for its band, massage treatment itb, massage treatment band
IT Band Massage: SELF CARE
- Deep moist heat to loosen IT Band ( if there is no inflammation)
- Contrast hydrotherapy to increase circulation
- Ice to lateral femoral condyle with acute friction syndrome
- Self-massage to IT Band and TFL (foam roller)
- Stretch TFL, especially if seated for long periods. ( with arms raised, affected leg behind, front leg lunged down, bend sideways)
- Rest, ice, compression, and elevation (RICE).
- Anti-inflammatory medications, like ibuprofen (Advil, Motrin) and naproxen (Aleve), may be helpful. …
- Home treatment can involve stretching, massage, and the use of foam rollers at the site of pain and inflammation.
- Stop Running. 1 of 6. Running exacerbates ITBS pain, typically at the knee insertion point, during the acute injury phase. …
- Cross Train With Cycling or Pool Running. 2 of 6. …
- Massage the Injured Area. 3 of 6. …
- Increase Strength. 4 of 6. …
- Sleep More. 5 of 6.
When a person bends their knee, the IT band moves to support it. If the IT band becomes inflamed, it can rub on the outer knee and cause pain, especially during movements that involve the joint, such as squatting. IT band syndrome often affects runners.
Treatments for Iliotibial Band Syndrome
If the pain from iliotibial band syndrome lasts for more than two weeks even if you are only stretching, your regular exercise routine, and ice and you don’t see much improvement, a chiropractor can help. Treating the tightness in the iliotibial band is the key to healing.
- Most importantly, always decrease your mileage or take a few days off if you feel pain on the outside of your knee.
- Walk a quarter to half-mile before you start your runs.
- Make sure your shoes aren’t worn along the outside of the sole.
- If you regularly wake up at night from hip pain, the way you’re sleeping or your mattress could be to blame. …
- Sleep posture can also cause pain.
- Try sleeping on your back or, if you’re a side sleeper, sleep on the side that doesn’t hurt and put a pillow between your knees to keep your hips aligned.
Common treatments include:
Flexibility and mobility work: dynamic stretching, static stretching, and foam rolling.
Key Points: Your dynamic, static, foam roll stretches should address the muscles that connect into the IT band: tensor fasciae latae, vastus lateralis, and glutes vs rolling directly on the fibrous tissue (see anatomy photo above).
Progressive strength training addressing the muscle groups of the core, hips, thigh, and lower leg.
Key Point: You should not reproduce your pain and/or snapping with any of your exercises addressing the quadriceps, hamstrings, glutes, and hip rotators.
Biomechanics training to address movement pattern dysfunction and gait abnormalities.
Key Point: Often movement patterns such as your gait, squats, and step-ups can be retrained in a mirror with the guidance of your physical therapist.
Activity modification like relative rest, reducing mileage and repetitive stress movements will help reduce friction and inflammation in the tissues as you heal.
Key Point: Rest is relative. If your body is used to running 40 miles per week, rest may be reducing your mileage to 20 miles per week.
IT Band Kinesio Taping
IT Band Exercises
- Hip Bridge with Resistance Band. An effective yet simple exercise, to begin with, is the hip bridge utilizing a resistance band. …
- Side-Lying Hip Abduction. …
- Lateral Band Walk. …
- Side Plank. …
- Standing IT Band Stretch.
PLUS, Try These-
Massage for IT Band
Given current research, treatment for ITBS should be in phases. The first phase requires a proper diagnosis and the identification of any causative factors. Once this is established, the next phase is aimed at reducing the pain. Rest may have to play a part during this phase, which also may include physical therapy modalities, ice, and stretching three times a day. Cross-training that does not aggravate the condition can be done to maintain fitness.
Deep tissue massage along the full length of the ITB can be started in this phase; Dr. Fredericson refers to this as mobilization of the tissues, and it is a necessary step before moving on to the all-important third phase of strengthening the hip and thigh muscles. Fadil recommends very frequent massage: up to every day for elites, and 2 or 3 times per week for recreational runners. If you cannot afford the expense or time of going to a certified massage therapist, a foam roller can work very well for self-massage (see www.smiweb.org obtain rollers).
There is no cookie-cutter massage routine for iliotibial band syndrome (nor hopefully, a cookie-cutter routine for any issue). Each individual is unique, and although the pain from this syndrome may be located in the same place on numerous clients, the response to it depends on the individual. Some people have high pain tolerance, some are stoic or stubborn about pain, and people with a low pain tolerance may seem more debilitated by it.
Regardless of modality, warm the area and do not work beyond the client’s comfort level. Some therapists think they need to go to the bone, regardless of the problem or how tender the client is, and that is not being client-centered in any way. The idea that light work is not as effective as using a heavy hand is false and outdated.
more info at:: https://www.runnersworld.com/advanced/a20797159/beating-the-band/ https://themusclemedics.com/it-band-pain-papillion-massage/
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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