Hey, this is the Sock Doc, and today I'm going to talk about a common
injury. It's called iliotibial band frictional syndrome, also known as ITB
syndrome. It's pain on the outside of the leg, most often in a runner's
knee. It's like an ice pick sticking in the outside of your knee, a really
tough pain to be dealing with. Most runners have it for many months,
sometimes even a half a year, where they can't run, or they're hobbling
home after a short little run. It tends to get worse and worse. Unlike
plantar fasciitis, which I talked about in my last video, which tends to get
better as you walk on it, usually, the iliotibial band frictional syndrome,
that pain only gets worse the more you use it.
So iliotibial band is actually a band of fascia that comes down the outside
of your leg here, and attaches to the outside of your knee. That's most
often where the sharp pain is, like an ice pick. The iliotibial band is an
extension of two muscles. One is the tensor fasciae latae, which is up here
on the side of the hip. The other one is the glute max muscle, which is
your powerful butt muscle that comes all the way down and actually
intertwines with the hamstring, here. About three-quarters of the way down
your leg, the connective tissue is. So with your tensor fasciae latae up
here, and your glute max, those fibers come down and wrap around, and make
up your iliotibial band. Basically, the iliotibial band, it's right around
25 percent of the tensor fasciae latae, and another 75 percent of your
glute max. That's what many people disregard as the power in their glute
max, and that fiber, those bands coming down and making up the iliotibial
band.
A couple things you want to look for, for iliotibial band issues. One is
you don't want to ice it. Ice just tends to tighten up the iliotibial band.
We don't want to do that. Sometimes warmth will work, at least to get you
over some general symptoms. It's not going to correct the problem. We're
going to get more into that in a second. The other thing you don't want to
do to the iliotibial band is stretch it. When you injure a muscle or
fibers, in this case, the fascia, you want to keep those connective tissue
muscle fibers joining back together to one another. The more you stretch
something, the more you elongate it, the further you keep the injury going on.
You're basically going to prolong the injury the more you stretch
something, especially the iliotibial band.
What are we looking at for the IT band? One is you might have an issue in
that TFL. You might have an issue in the glute max. Couple things you can
do is look for trigger points in there. See if there's any tender spots in
the iliotibial band, or any tenderness coming down the glute max, obviously
on the same side, as it wraps around into that final insertion point in the
iliotibial band. You don't want to mess around with the iliotibial band.
Stay off the band, especially the insertion point. It's just going to cause
more pain. So you're looking to treat the muscles that make up the band,
not the actual band itself. The second thing you're going to look for is
any problems with the lower leg. Look for trigger points on the inside of
the tibialis posterior muscle, behind the tibialis, like I showed in the
plantar fasciitis video. Also look for any tenderness down in the shin
muscle here, your tibialis anterior. Very commonly people get shin splints.
So that's another area to look at. A third area to look for tenderness, is
the inside of the knee here. What happens is, I'll show you on this side,
there's three important muscles that attach to the inside of the knee. When
one, two, or even all three of these muscles fatigue, what happens is the
muscles on the outside, and now a major part of the iliotibial band
insertion, that spasms because of the weakness on the inside. You get an
imbalance between the inside and the outside of the knee. Three muscles
that attach right here on the inside of the knee are all related to your
adrenal glands.
When someone's under a lot of stress, that means anaerobic workouts,
training at too high a heart rate, racing too much, someone who's under too
much mental or physical stress. They're pushing themselves too hard,
there's family issues, there's work issues. Those muscles are actually a
very good reflection of how much hormonal stress you're under. Even a poor
diet will do it. A diet with hydrogenated fats in it, MSG, too much refined
sugars, will actually affect the muscles of your knee, and these inner knee
muscles here that support your joint. Then you can end up with a spasm in
that band as it tries to support the area. So a big key point here is that
the iliotibial band is a reflection of other things off in your body, in
this area, and it's trying to support the problem. So we're not going to
fix the iliotibial band by fixing it directly, but by addressing the root
cause of it. In this case, if you have tenderness right in that area, it
could very well be because you're under a lot of stress, and it's an
adrenal gland issue.
So, the fourth area we're going to look at is gait. Stand up. What happens is, if she had
an iliotibial band issue on this side, every time she steps forward with
her right leg, these muscles in the front of the thigh should be firing. In
a normal gait position so should the muscles on the upper body, on the
opposite limb, so this arm muscle. As these work, these work in harmony. As
you switch your gait to this leg, as this leg goes forward, the extensor
muscles on this side, so her glute max now on the right side, as well as
the triceps on this side, are also firing. That's how someone normally
walks. Let me do it correctly. Like this.Extensors on the opposite sides
are firing in regards to your lower leg muscle and your upper arm muscles.
So triceps and glute max, here, on this side, and here, and then flexors on
the upper body, and flexors on the lower body, on the leg that's forward. Sit back down.
So she steps forward. If she was having an iliotibial band on this side, as
she steps forward, and these muscles aren't supporting her well, maybe her
tensor fasciae latae is a flexor, making up part of that iliotibial band.
That could be because of a flexor problem, maybe a bicep problem, maybe a
shoulder problem on the opposite side. Or the extensor problem, if it was
her glute max, which makes up 75 percent of that iliotibial band, that
could be fatiguing on her because of an extensor problem on this opposite
side. Maybe in the triceps, back of the shoulder, or that area. She
actually needs to be looking to treat this area. Maybe there's some
involvement up there. Maybe there's some imbalance that she could
investigate with her therapist or doctor. Don't disregard the gait. It's a
big deal. So that's three areas. We've got the local muscles again, tensor
fascia latae, we've got the glute max, that's considered one. Two is the
inner knee muscles. If it's an adrenal gland issue it might be tender
there. Three are the lower leg muscles to support the knee joint. Four is
the gait imbalance. Five is actually the foot muscles.
The strength of the feet, like I talked in the plantar fasciitis video, is
very important for your gait. Very important to support the rest of your
body, pronation, shock absorption. Go barefoot as much as possible, like
I've always preached. Stay away from those orthotics. The more you wear
orthotics, the more you're going to fatigue your feet, throw off your gait,
and eventually end up with a problem. It could be an iliotibial band
problem. It could be plantar fasciitis. It could be a shoulder muscle
problem from the way that you're throwing your gait off. Think minimalist
shoes, too. She wears Nike Frees 3.0. Pretty good minimalist shoes. Lots of
others out there. Remember when you're buying shoes, keep them nice and
level. Not much of a drop, not much of a heel on them, and you should be
able to bend them in any direction. Good old Nike Frees have grooves in
them. There's the rock stuck in there. You should be able to turn them and
twist them in any direction possible, and a nice wide toe box for the toes
to splay out. When you're not wearing shoes, try to be barefoot as much as
you can.
Watch the feet. Look for the adrenal gland issues. Look at those other
muscles that you probably haven't considered before. No icing. It's just
going to tighten that IT band up more. No stretching. It's going to
irritate the fibers and elongate and stretch them, and stretch out the
length of your injury. Look at the opposite gait. Don't forget about that
glute max importance, especially if you're a cyclist or a runner. It's
pushing up hills. Big muscle to use. That's it. Thanks for watching.