Newsletter # 8
The ITB (iliotibial band) is well known among runners as a source of problems. This article explains relevant anatomy, possible causes of ITB related problems and what can be done.
Anatomy
The ITB is a band of fibrous tissue on the outside of the thigh. It starts at the outer lip of the hip bone (the iliac crest) and ends just below the outside of the knee on the tibia. Towards its end, the ITB blends with fibres of the joint capsule of the knee and the ligament on the outside of the knee, the lateral collateral ligament or the fibular collateral ligament.
The top of the ITB also provides a point of attachment for two muscles around the hip - gluteus maximus and tensor fascia lata. Both blend with the ITB around the level of the greater trochanter.
Function
Because of its position on the outside of the thigh and knee and its attachment to gluteus maximus and tensor fascia lata, the ITB adds lateral stability to the knee. Problems occur when muscles primarily responsible for this stability (gluteals) are weak for whatever reason. In this instance ITB can become overactive in an effort to compensate. This causes the ITB to become tight.
Potential Problems
As the knee bends or straightens, the ITB moves back and forth across the outside of the lateral condyle of the femur. A tight ITB can therefore cause pain at this point on the outside of the knee. It can even be felt 'flicking' over the outside of the knee otherwise known as 'runners knee'.
A tight ITB can also be a source of pressure on the bursa of the greater trochanter as the bursa is effectively 'squeezed'.
Also, a tight ITB can cause lateral tracking of the patella. In other words, the patella is pulled to the outside as the knee bends and straightens causing problems with the patellofemoral joint.
Pain in ITB can be spread along the outside of the thigh. It can be quite debilitating if sufficiently painful.
Causes
I often find a tight ITB to be associated with poor stability. A lot of the stability comes from muscles around the hip. This weakness and instability causes other structures such as ITB to become overactive.
If I suspect instability, I include the following tests as part of my assessment. You can do the balance tests in front of a mirror to give you some visual clues.
Tests
Balance on your good leg for 10 - 20 seconds. Then do the same on your affected leg. Is there a difference?
Now,
keeping your trunk upright do a single leg squat. Again, note any
difference in stability or control.
Test
gluteus maximus:
Lay on your front with the leg to be tested bent to about 90°. Now lift that leg (your knee might bend more).
Do 10 - 20 repetitions and compare the two sides. If you can, get someone to gently resist the movement a couple of times and compare the two sides. Is there a difference in strength? If so, make this a strengthening exercise to do.
* When doing this movement try not to arch your back or push through the straight leg.
Test
gluteus medius:
Lay on your side as shown with your trunk and pelvis vertical. Bend the lower leg. Keep the upper leg straight.
Lift the upper leg so your foot is just above your hip. Repeat 10 - 20 times. Again have a friend resist one or two on both sides to give you an idea of the strength. If there is a difference, make this a strengthening exercise to do.
* When doing this movement try to keep your trunk vertical.
What you can do about ITB problems
- Initially, rest may be appropriate particularly in cases where a tight ITB is causing hip or knee pain or pain along the outside of the thigh.
- Make sure you have good strength and stability as outlined above - you can use these muscle tests as strengthening exercises.
- Stretch the appropriate muscles - gluteals and quads. The ITB itself is very difficult to stretch so a few massage sessions may be required. Alternatively use a foam roller.
- An analysis of your alignment and running style may be required - overpronation may cause the knee to turn inwards potentially leading to ITB problems.
I hope you find this information useful.
Enjoy your running!
Simon
simon@expertrunningguide.com
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