IT ( iliotibial) band syndrome is often diagnosed among the athletic population. It is commonly known to cause pain at the lateral aspect of the knee and can be quite problematic for an athlete, as the pain can limit their ability to train. Foam rolling the IT band is the most common treatment issued for managing IT band syndrome, often in conjunction with NSAIDS and a brace. The purpose of this article is to provide a different perspective on treatment of the IT band, focusing more on treating the cause of the pain instead of just focusing on the soft tissue quality and length of the IT band.

The IT band originates at the iliac crest and inserts at the lateral portion of the tibia. It functions as a fibrous reinforcement to the surrounding tissue and stabilizes the knee joint in extension and partial flexion. In combination with its associated muscle groups, the IT band serves to extend, abduct, and externally rotate the hip.

Activities such as running, walking, cycling, and rowing done with improper mechanics can aggravate the IT band. IT band syndrome typically presents as pain at the lateral knee. The pain is often reproduced with flexing and extending the knee, going downstairs, lying on the affected side, and is usually painful during and after recreation.

When the IT band is over stressed, it can pull on the connecting tissue attaching to the patella, causing patellar tracking dysfunction and knee pain. The band also runs the entire length of the femur, and when overused can also cause pain at the trochanteric bursa. While foam rolling, using other devices to roll out the IT band (such as The Stick or a tennis ball), bracing, and NSAIDS may temporarily stop the pain and help an athlete get back to exercise, for long term symptom management the biomechanical errors that cause the excessive stress on the IT band must be addressed. These impairments can originate in multiple areas of the body, starting as high up as the neck.

Excessive flexion at the thoracic spine and a forward head posture shifts an individual’s center of mass anteriorly, creating a quadriceps dominant movement pattern vs a gluteal pattern. When a person becomes quadriceps dominant, the hips weaken, causing the femur to adduct and internally rotate in weight bearing. This position places excessive stress on the IT band. Moving further down the spine, core weakness can also cause IT band pain. When a person is weak in their trunk, they can develop excessive frontal plane motion during ambulation and pelvic instability, causing sacroiliac joint dysfunction. These biomechanical impairments also cause femur internal rotation and adduction, thus stressing the IT band. Moving all the way down to the big toe, if an athlete lacks extension in the great toe, they will point their toe out to the side during ambulation which will cause them to collapse in their arch. Collapsing in the arch causes the knee to dive into valgus, then creates femur adduction. From this paragraph, one can see that treating IT band syndrome is not as easy as just foam rolling. To truly understand why an athlete is having IT band discomfort, a comprehensive movement evaluation, range of motion assessment, and strength testing must be performed.

If you experience chronic IT band syndrome, consider consulting with a physical therapist or qualified fitness professional to determine the root cause of the pain so you can effectively resolve the condition. Simple foot exercises, a core stabilization program, orthotics, or a spinal range of motion program may be the answer to your pain, and you can set the foam roller to the side.

Carla Pryor PT, DPT, OCS, RYT 200. Co Owner of Redefine Health and Fitness located in North County San Diego. Redefine is a wellness based company focused on providing excellent comprehensive and research driven care to assist clients in meeting their fitness and nutrition goals. Contact carla@redefinehealthandfitness.com for further inquiry.