From rowing & CrossFit to running & cycling, we know that IT (Iliotibial Band) Syndrome is one of the more common knee pain struggles out there for athletes (see this article and this one too).
Many of these athletes experience multiple episodes of this kind of pain, even after trying the normally prescribed treatments like rest, NSAIDs, or foam rolling or “stretching” their IT Band.
My clients that end up in this painful situation usually end up asking,
“what am I doing to keep causing my IT band to flare up?”.
The fact is, we usually can’t blame things like this on only one factor. Even in it’s name, IT Band “Syndrome” (syndrome – which literally means “a group of symptoms”) kind of alludes to the fact that there are multiple pieces of the puzzle that make up this condition.
Like in most things, there usually isn’t a quick fix.
HOWEVER, there are consistent similarities that athletes struggling with persistent lateral knee pain share. So for those of you who haven’t been able to fix your IT Band problems for years, and for those of you who are looking to try to prevent this kind of problem while running, biking, or CrossFitting in the future…here is exactly what I recommend to my patients…
(1) WORK MORE ON LATERAL HIP STRENGTH
There are several studies in the sports medicine world that have found an association between hip weakness and IT Band-associated pain. These studies don’t show that hip weakness causes IT Band-related problems, but the relationship between the two is worth looking into. As always, a thorough evaluation from a good local Physio can go a long way in helping you to identify where your individual weaknesses are and what path to go down in creating a treatment plan. At Limitless, my triathletes and runners tend to struggle more with lateral hip weakness, whereas my CrossFitters and strength athletes tend not to.
Here is my favorite sequence of movements to fire up those lateral hip muscles (the gluteus medius in particular):
THE “HIP MATRIX”
ROGUE BAND SIDE STEPS
(2) Be more conscious of your knee position
If you were throwing a ball back and forth with a friend and your elbow started to hurt with each throw, what would you do?
Would you kind of ignore it and keep throwing the same way as before?
Would you try to change the way you’re throwing, even though that way of throwing had never bothered you before?
The same goes with running, cycling, squatting, lunging, snatching…but it’s kind of controversial isn’t it? On one hand, you don’t want to alter the way you’ve done something for years and potentially screw up your form. On the other hand, if your form continues to be linked somehow to pain, then isn’t it a little crazy to stick with something that’s not helping?
One specific thing about “form” that I see pretty consistently is that many athletes with ITB problems struggle to control their knees against valgus or femoral adduction and internal rotation (pictured) moments.
The stress on your knee in this position is less than great…and while every once in awhile it’s no big deal (many elite olympic weightlifters and CrossFit athletes have moments of valgus coming out of the hole in a deep squat for example, see this awesome article by Dr. Zach Long for more), it’s a not a position we want to promote – especially in a loaded, repetitive manner.
So with that in mind, here are a few drills I have my patients work through to make sure (1) they’re a bit more aware of their knee position, and (2) to try to get better at controlling it.
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(3) Be consistently gradual about how you increase your physical activity level
One of the most common reasons I see injuries in endurance and CrossFit athletes is that the person’s ramp-up into higher level training (CrossFit comp/Open/Regionals preparation, increased running mileage, increased swimming distance, for examples) does not match their training level.
Don’t get offended…
I get it. You’re elite. You’re strong. You’re fast. But sometimes we push ourselves past where our body is truly at. And most of the time, our body handles that just fine because the human body is INCREDIBLE at adapting and accepting new inputs/challenges. That’s why we can hit PRs, endure events that don’t seem humanly possible without injury, and make it through accidents without a scratch.
But some of the time, our body tissues haven’t been given enough time to adapt to heavier/faster loads. Some of the time, our body tissues get pretty angry at us when we push them more than where they’ve been trained to be.
The solution?
I give my patients a few rules:
(A) INCREASE YOUR WEIGHT/DISTANCE/VOLUME GRADUALLY
…NOT suddenly!
(B) DON’T FOCUS ON ONLY ONE PART OF YOUR SPORT
Don’t spend the entire year working on only strength, power, speed, etc.
CrossFit athletes – learn/get coached to run, swim, row , on lifting technique and how to do Olympic lifts well under fatigue, learn how to endure.
Endurance athletes – learn/get coached in speed training and technique; run with friends and run alone, work on learning more about how to recover well.
(C) WORK ON YOUR WEAKNESSES
Do you know that you have some mobility/stiffness problems going on with your ankles or hips? Work on that…
Do you know that you have some strength differences from side to side? Work on that…
(4) STOP WASTING YOUR TIME STRETCHING THINGS THAT DON’T ACTUALLY STRETCH
It takes over 2000 pounds of pressure to cause the IT Band to “stretch” or change just 1%. So unless you’re hiring a farmer to hoist a bull onto your outer leg OR you’re going to have a small car run you over, you’re probably not actually stretching your IT Band as much as you think you are with some of the stretches that are out there on the internet.
Check out this article to read more.
If you’re going to foam roll or stretch, I’d recommend instead focusing on the more malleable areas of the hip that attach to the IT Band such as the gluteal muscle groups and the TFL (video below).
Looking for More Help with IT Band Pain? If you live in Michigan, tap or click below and we can setup an in-person or Telehealth/Skype session to put together a plan of action for fixing that pain once and for all:
So there you have it: 4 of the most common things that I recommend to try to fix that lateral knee pain once and for all.
Have you struggled with IT Band Syndrome and found success with anything else? I’d love to hear about it!
