Iliotibial band stretches to reduce pain.

Try these expert tips to effectively deal with tension and discomfort.

The IT band, also known as the IT band, is not only one of the most common culprits common causes of knee pain in runners, it is also one of the most commonly misunderstood parts of our athletic body. Understanding why the IT band can become a source of pain requires first understanding the anatomy.

What is the IT band?
The IT band is an thick, fibrous band of fascia, a type of connective tissue, that runs from the tensor fasciae lata or TFL (no, it's not a Starbucks drink) and the gluteus maximus at the hip to the knee along the outer portion of the thigh. Along the way it connects the pelvis (iliac crest) just below the knee (tibia) as the name suggests. The main function of the IT band is to stabilize the knee, assist with inward rotation, and assist with hip abduction.

Contrary to popular belief, this band is a connective tissue, not a muscle, so it can't really stretch. Physical Therapist and Triathlete, Bridget Dungan, DPT, says that based on current research, it would take a lot of force to stretch the IT band, more than anyone could generate on their own.

If you experience tension in the IT band, you may feel a sensation caused by the tension in the muscles around the hip and the IT band. The most common IT band stretch (crossing one leg behind the other and pushing the hip to the side) is more of a tensor fascia lata stretch, which might be helpful if the TFL is tight. Stiffness can also result from stiffness of connective tissue, which can be relieved by myofascial self-release in the form of massage or rolled foam.

If your experience is more painful than the average feeling of tension, your IT band may be aggravated as it passes through bony prominences, which can cause irritation, pain, or even IT band syndrome.

What is IT band syndrome?
IT band syndrome (ITBS) is an inflammation of this large band of connective tissue (the iliotibial band or IT) It runs along the thigh, according to Jordan Metzl, MD, a sports medicine physician at Hospital for Special Surgery in New York City. According to research, IT band pain is very prevalent in endurance athletes such as cyclists and runners, with more than 15 percent of cyclists and 22 percent of runners experiencing it.

Symptoms of ITBS include sharp or burning pain on the outside of the knee and / or pain on the outside of the thigh. The pain may remain localized or radiate up or down. "IT band syndrome is often attributed to IT band 'tension'," Dungan says.

However, Dungan says the root of the problem is often poor body mechanics that causes friction or compression of the IT band and the underlying tissue where it connects to the knee.

So how does this translate to running? Dungan says that excessive internal rotation of the hip and adduction of the knee (when the knee hits inward) can cause irritation of the IT band or the fat pad underneath it. This can occur as a result of weak buttocks and / or poor neuromuscular control at the hip and / or ankle. She suggests that targeted strengthening and movement retraining with a movement specialist, such as a physical therapist, can help correct these mechanisms. Unfortunately, rolled foam on the IT band, while it may help a little, is simply not enough.

So what can you do if you feel pain in the IT band before, during or after a run ? Here are some tips from the experts.

1. Stretch the muscles around the IT band.

There is a place for stretching when treating ITB stiffness, but it is not stretching that cannot be stretched. To stretch your hip and thigh muscles, try the following stretches.

Lengthening stretch:

This movement stretches the tensor fasciae lata, a muscle that runs along the hip and outside of the leg. Cross your injured leg behind your other leg and lean over to the good side. First, stretch your arms overhead, creating the shape of an arch from the ankle to the hand with the injured ITB on the outside, then lower your arms to touch the ankle on the inside of the arch. Hold for 15 seconds and repeat 10 times. Perform 3 sets a day.

Clam shell:

Place a resistance band around your legs just above the knees and begin by lying down on your left side with your head resting on your left arm, knees bent and stacked. Slowly raise your right knee toward the ceiling to spread your legs like a shell. Perform the exercise slowly. Do up to 3 sets of 10 reps on each leg. When this exercise becomes easier and the leg remains pain free during the process, you can move on to a more advanced strengthening.

Side plank with leg lift:

Begin by lying on your left side with your legs straight and feet stacked. Raise your right leg up, then extend your leg back in that plane, move it forward, and then return it to the starting position. The shape is very important. Check that you have a straight line from shoulder to ankle with the upper hip slightly in front. (Don't let your upper hips roll back.) Go through the sequence slowly with the toe pointing downward. Do up to 3 sets of 10 reps for each leg. Once you can handle that painlessly, do the more difficult movement by lifting your body into a side plank position with your shoulder directly over your elbow and your hips lifted as shown. Perform up to 3 sets of 10 reps for each leg.

One Leg Squat:

Begin to stand up and shift the weight to your right leg. Swinging on your right foot, send your hips back and bend your right knee to lower a quarter of the way down into a squat. Make sure the knee remains straight on the foot and does not collapse inward. Extend your arms outward for balance.

Once you've mastered the straight squat, make the exercise more challenging by mimicking running form, extending your leg unsupported behind you and pulling it closer to lift knee in front of you. Ultimately, work your way down to the ground in front of you on the forward lean. Then you can move on to hold a medicine ball overhead.

Hip walk:

When strong enough, eccentric strengthening works the hip abductors in the same way that they work during the race. Stand with your left foot on a step or ladder and let your right foot dangle. Place your hands on your hips for balance, then lift your other foot by lifting your hips on that side, while taking care to stay straight and upright. Slowly lower your hips to the bottom of your range of motion, while standing tall. Perform 10 reps on each side and increase to 3 sets.

2. Strengthen the glutes.

According to research conducted at Stanford University, strengthening the gluteus medius and maximal is the most important step in avoiding pain related to ABI. Regarding strengthening, Michael Fredericson, MD, suggests that athletes perform exercises like Clamshells, Abduction Straight Leg Raises, Glute Bridges, Hip Walks, and Single Leg Isometric Wall Presses. He also developed a protocol (known as "The Fredericson Protocol for ITBS") to help guide athletes toward the correct strengthening regimen.

3. Use foam rollers.

Although the research on foam roller efficacy is inconclusive, it sure feels good to experience such pain. However, instead of focusing on the IT band, try to focus your foam by rolling on the quads, glutes and hamstrings to help your muscles warm up and cool down before and after races.

4. Rest.

If you experience pain before, during, or after a run, in addition to walking or daily activities such as climbing stairs, you may need to take a short break. By continually performing the same repetitive movements that are causing your pain without addressing the real root of the problem (potentially weak hips or poor bike fit), the only cycle you will remain in will be one of more pain and inflammation.

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