If you’ve been an active runner for an extended period of time you have likely experienced bouts of lateral (outside) knee pain at some point in your career. The chances are also pretty high that the pain you were experience was caused by a tight iliotibial band (ITB).
Ilio-wha? Yeah, I know, more anatomical jargon. I’ll break it down for you. In between your hip, down the outside of your thigh to just below your knee joint, there is a thick band of fascia (which I spoke about in the Graston blog) that as new research shows anchors deep to your femur (thigh bone) as well as connecting to your tibia (leg bone). Take a look at the picture below for a better idea.
The conventional wisdom about this band was that as you flexed your knee that it would shift from front to back, gliding over the outside of the knee, which when over used would create friction and cause pain. New research gathered by one of the leading experts on disorders of the lower extremities in the chiropractic community,Dr. Thomas Michaud, DC, suggests that this really isn’t the case, and that traditional methods of treatment for ITB syndrome tends to be ineffective because they don’t focus on where the problem originates.
According to evidence gathered by Dr. Michaud, the band does not actually move much, if at all, and only stretches an additional 0.2 percent longer than it’s resting length. Which, if you’re playing the home game, is not very much at all. Believe it or not, this is a really good thing. The ITB’s job is to act as a stabilizing cable which prevents the femur from bowing when we walk, run, jump, etc. Were it to be more flexible, you’d have a hard time doing anything without risking fracture and other injuries.
The reality is that the muscles in the hip (specifically the gluteus maximus and tensor fascia lata) put a great deal of stress on the lower anchor of the ITB and cause it to pull away from the femur, which leads to inflammation, and ultimately, pain. You’re probably asking what, if anything this has to do with how this new information changes the way people like myself address this problem. Well I’ll tell ya, it pretty much changes everything.
For as long as this has been a problem for people, MD’s, DC’s, DO’s, PT’s and the like have mostly taken an approach towards working out the tension at the site of pain, when really, the problem is in your hip. So while I do think that the sticks and foam rolls can help, I think in this case they are being used incorrectly by a large portion of the population and addressing less than half of the problem.
As I mentioned earlier the glut max and TFL really control the tension in the ITB and should be the focus of the majority of treatment. Without focused effort on correcting muscular imbalances, removing fascial adhesions and working on other biomechanical factors that have been shown to contribute to ITB syndrome, the chances of you getting any lasting relief are not much better than doing nothing at all. If you are looking for a chiropractor in Denver call us and get assessed to see if you could benefit from treatment and get back out on the trail pain-free. If not, check out the ACA’s doctor search to find one near you!
For some tips on how to strengthen your hip at home you should check out this article from Runner’s World magazine that offers runners some great tips for exercises that help with running related knee pain.