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Treating the Problem Rather Than The Symptom

It’s 4 months from that big fall marathon when the pain begins.  The discomfort starts as a twinge on the outside of the knee, but quickly progresses into a much more debilitating pain.  All eyes turn toward the knee and you start to remember all that hearsay from your Uncle Don and Aunt Nancy about how bad running is for your knee (side note: not true). But the problem isn’t the knee, it’s the IT band: a fairly well known injury in running circles, but often a poorly understood one.  Now what?  Rest, foam roll, massage, stretch, ice, ibuprofen.  Rest more, foam roll more, massage more, stretch more, ice more, take more pills (better to put the kidneys at risk as long as you fix the IT band, right?).  Aside from perhaps a brief respite, nothing is working.

But why is this happening? You traded out your shoes every 300 miles, you’ve been eating right, sleeping more, and most importantly, you were very smart and careful about your mileage build.  So why are you being plagued now with this “tight” IT band?  And why, as diligent as you’ve been, isn’t any of the stretching and foam rolling and icing making a difference?

Well, it’s probably because you’ve been treating the symptoms and not the underlying problem.  We will get to that, but first, a little background.

The IT band is more formally known as the illiotibial tract, and is a thick band of fascia, not muscle, that runs from your pelvis, down the outside of your leg, over your hip and knee, and inserts just below the knee. Fascia is made up of collagen – the same stuff that makes up tendons and ligaments – and doesn’t respond nearly as well to stretching as muscles do.  That may sound bad, but because of its composition, it doesn’t tighten in nearly the same way muscles do either.  So much for the “tight” IT band diagnosis.

Now back to the underlying problem.  While the IT band doesn’t stretch and get tight in the same way that our muscles do, the fascia is still susceptible to muscular influence.  The distance that the IT band travels – from above your hip to below your knee – brings it in contact with numerous muscles, all of which can influence the IT band in different ways.  But not all muscle groups are created equal in regard to IT band influence.  Lately one muscle in particular, the tensor fasciae latae (TFL), has been thought to be the overwhelming contributor to IT band pain.  When the TFL gets tight it places undue strain on the IT band, and can cause the IT band to compress against the femur further down the leg on the outside of the knee.

So we’ve found the underlying problem, right?  Just stretch the TFL and we’re golden.  Wrong, kind of.   While stretching the TFL isn’t a bad idea (here’s how if you’re interested), the real question involves what is happening to make the TLF so tight.

Enter the gluteal muscles.  The gluteal muscles and the TFL both pull on the IT band and put it under tension during various movements.  While the gluteal muscles should be some of the strongest in the body, often they are incredibly weak and underutilized.  When there is significant weakness in the gluteals, the TFL is forced to take on a much larger role and will eventually become overworked and tight.  So now we’ve actually found the underlying problem.

Simply put:  Weak butt = TFL overuse = TFL tightness = IT band compresses over knee = Knee pain

How can you fix it?  It’s a pretty simple answer: you need a stronger butt.  Fixing the first link in the chain is the most important thing you can do.  Once that is taken care of, everything else gets easy.  Take the time everyday to work in a variety of glute strengthening exercises, like clams, side-lying wall slides, ball bridges, and hip abduction exercises in general.  Be sure to work BOTH sides, even if it only hurts on one side.

It won’t hurt to stretch the TFL and all the surrounding areas, but if there is any kind of muscular imbalance the stretching won’t really do much.  Even if your IT band feels great there’s still a good chance that some sort of weakness and imbalance still exists, so be proactive and don’t give things a chance to become major issues.  Hopefully your new, strong butt will get you back on the roads and trails in no time!