Can’t run because you have “bad knees”? Well, are you sure it’s your knees that are “bad”? Very often, people write off their knees as “bad” when they experience knee pain while exercising. Consequently, they give up all activity, consider the pain as “part of growing old”, accept their love handles and drop their gym membership. As a trainer, this KILLS me, as well as my wallet, because most lateral knee pain is a result of IT Band Syndrome, not “bad knees”!
TFL and IT Band
The Iliotibial Band (ITB) is the sheet of fibrous connective tissue that surrounds a rather small hip muscle called the Tensor Fascia Latae (TFL). The long band originates at the top of the hip (ileum), runs along the outside of the thigh, and inserts on the outside of the knee (tibia); hence, its name, Iliotibial Band. The TFL’s function is to assist in flexing, medial rotation and abduction of the hip and extension of the knee joint-all the hip and knee actions we perform while walking, running, climbing stairs, lunging, and squatting. Since these are common activities for the average exerciser, it’s easy to see how the TFL muscle can be overused and the IT Band can become irritated.
IT Band Syndrome
Iliotibial Band Syndrome (ITBS) is one of the leading causes of lateral knee pain in frequent exercisers, especially runners. The lateral knee pain is generally caused by the ITB pulling upward on its insertion (see above) by the TFL and/or Gluteus Maximus muscles. To relieve this pain, ibuprofen, massage therapy and cold compresses applied directly to the knee can help until you can seek professional help. To prevent this injury, and aid in its recovery, hip stretches are essential.
ITBS Recovery
To ensure a speedy recovery, stop running immediately; easing off speed, or cutting back on miles isn’t enough to help in the recovery of ITBS. Find an alternate mode of exercise, but make sure you give yourself a long, hearty warm-up. In some extreme cases of ITBS, heating the hip before exercise can help loosen the muscle and relieve pain for the first few minutes of the warm up. After exercising, stretching the entire hip area and icing the ITB and knees are mandatory!
Stretch Sequence
Start your stretch with the TFL; begin in a standing position. Hold your right hand securely on a solid surface to support your body as you cross your left leg behind and past your right until you reach a maximum stretch. Follow this with by extending your left hand straight overhead and tilt your upper back to the right side while simultaneously pushing the left side of the hip. Hold for 30 – 60 seconds. Stand upright, switch legs and repeat stretch on opposite hip.
To stretch the Gluteus Maximus, lie supine on the floor and bend both knees with feet flat on the floor. Bring your right knee towards your left shoulder and hold it in place with your left hand for 30 – 60 seconds. From the Gluteus Maximus stretch, move on to stretching the Piriformis by drawing knee toward floor with support of left hand. Carefully return both knees to center, lower one foot at a time to the floor, then repeat Gluteus Maximus and Piriformis stretches on other side.
Next, address the front of the hip with a Hip Flexor stretch. There are a variety of standing, kneeling and prone stretching options to choose from, but I like to combine a Hip Flexor stretch with back extension, so I recommend a yoga pose: upward facing dog. Lie on your stomach and place hands (palms down) beside ribcage. Use hands and arms to press ribcage skyward. For individuals with excessively tight hip flexors, abdominals, and/or hip flexors, the ribcage will barely get off the ground and the triceps will fatigues quickly. In this instance, hold stretch as long as possible, otherwise, hold stretch for 30 – 60 seconds.
Preventing ITBS
Some simple rules to follow to prevent ITBS, or its return, are: be diligent about warming up, stretch after exercise-especially after running, get new running shoes every 300-500 miles, and consult your physician at the earliest signs of pain. Don’t let ITBS stop you in your tracks!
