IT Band Syndrome (ITBS) is one of the most common complaints among runners. It’s one of the “dirty half dozen” running injuries. IT Band syndrome usually feels like a sharp, stabbing pain along the outer side of the thigh and knee.
The IT band is a thickened region of connective tissue along the lateral side of the thigh, extending from the top of the pelvis to the tibia. It’s not actually a structure all by itself, but is a thickened region of the connective tissue (fascia) that wraps around the entire thigh. And, like any other fascia, it does not have many neural receptors for sensing pain.
So how can it hurt then? The answer: it can’t.
Unless there is actual inflammation along the lateral knee, pain from ITBS is nearly always due to tight, painful areas of the vastus lateralis, the largest muscle of the quadriceps, which lies directly underneath the IT band. The fascia forming the IT band is woven into the muscle fibers of the vastus lateralis. When the vastus lateralis tightens from overuse, the fascia gradually shortens, preventing the vastus lateralis from relaxing to its resting length. As the muscle tightens and the fascia shortens, blood flow is restricted, and lactic acid and other muscle by-products accumulate in the tissue. This creates pain along the lateral side of the thigh and knee.
So why do the quadriceps get overused?
The quadriceps are knee extensors that function together with ankle plantarflexors (soleus and gastroc) and hip extensors and abductors (the glutes). When the three groups function together, the lower limb is very effective at shock absorption when landing and at propulsion when pushing off. The three groups are mechanically dependent on each other for normal function.
The calf, quads, and glutes are also neurologically linked through stretch reflexes. Normally, stretch of the soleus when the foot lands on the ground activates reflexes that control up to 75% of the hip extensor strength and about 50% of quad strength. If the calf gets tight, the hip becomes inhibited and loses up to 75% of its strength. The quads lose up to 50% of their strength. And the tight soleus also inhibits itself, losing up to 60% of its own strength.
So a tight calf produces weak calf muscles, weak glutes, and weak quads. Good recipe for an overuse injury. With the hip and calf nearly out of commission, the quads take on more of the load during running. They get overused, tighten, and develop painful trigger points that produce localized pain along the lateral thigh and referred pain to the lateral knee.
The good news is that the issue is not “weak” muscles that lead to lateral thigh and knee pain. The issue is “inhibited” muscles. Even better news is that the inhibited muscles are only inhibited because of tight muscles elsewhere.
And more good news… the symptoms of lateral thigh and knee pain will go away with the right treatment of the proper muscles.
Roll the Right Muscles in the Proper Way
First, roll the SOLEUS from the heel to the top of the calf with a relaxed foot. The soleus controls reflexes to the quadriceps, so loosening the soleus first is the key to getting the vastus lateralis to relax.
Second, roll the VASTUS LATERALIS along the entire length of the lateral thigh with the MyoReflex Roller. Dig deeply into the vastus lateralis to work out tight, tender bands of myofascia. If the IT band is tight, the MyoReflex will certainly loosen it for you.
In many cases of ITBS, treatment of the soleus and the vastus lateralis will fix the problem. In tougher cases, the vastus medialis and the gluteus medius need to be treated too. Check out the video on IT Band Syndrome for more details.