Jimmy has helped many clients in injury prevention, rehab and performance improvement through gait analysis (you can read about gait analysis here) he conducts at PACE Labs. So thank you Jimmy for your contribution to this series and to those looking for additional help. Please consider giving PACE Labs a call and visit them on Facebook here.
The most common misconception about the IT Band is that it is a muscle that runs down the length of the upper leg on the lateral (outer) side. It is in fact connective tissue coming from the tensor fascia latae (TFL) muscle of the hip and that runs the length of the thigh and attaches to the lateral condyle of the tibia. This basically means the IT Band is just one big tendon that uses the TFL to laterally stabilize the knee as well as flex, abduct, and internally rotate the hip. By eliminating the idea that the IT Band is a muscle we can turn the focus to the muscles around and connected to it that cause it to become inflamed and painful.
Tightness or weakness in any combination of the TFL, Medial Glute, PSOAS Major, Gluteus Maximus, and Vastus Lateralis can cause IT Band Pain. At this point I will point out that some studies have linked excessive pronation and IT Band issues but those cases are minimal and won’t be addressed here.
The Gluteus Maximus and TFL both actually attach to the IT Band so they are usually where we start when checking for muscle imbalances. After that the Medial Glute followed by the hip flexors, hip adductors, PSOAS, and lastly the Vastus Lataralis. The easiest way to determine the weak link in your chain is through a movement screen and I highly recommend you locate a place in your area that is proficient in screening if you have been suffering from IT Band pain. If you can’t find a place or just want something to try on your own I’ll give my three go to exercises that will typically help strengthen imbalances in the hip complex and allow the excessive tension to be released from the IT Band.
1. Single Leg Squats: It’s ok to just start with a basic squat and build your way up to the single leg squats if you are a beginner but no exercise works the entire hip and leg complex better than a squat. A single leg squat is done by standing on one foot and lifting the raised leg straight out in front of you. While maintaining good balance lower yourself down into a squatted position stopping when you begin to lose balance and control. This is typically the point where the weakness in your range of motion is and the goal will be to strengthen it by holding in this position for a second before returning to the upright position. Perform two to three sets of this exercise for 10-12 reps if you can do that many with good control. If you cannot perform that many with good body control then stop at the rep number where control is lost and then work to build on that. Keys to focus on are good knee stabilization, maintaining a straight and upright back, and not leaning too far forward.
2. Lateral Lunges: These are a great exercise for strengthening the inner and outer thighs along with the glutes to create good hip stability. Stand with your feet together and step out to one side. The step should be long enough that when you drop into the lunge position the bent leg maintains a knee over the foot position. After stepping out drop the hips down into lunge position keeping the chest up and back straight. Both feet should be flat on the floor and pointed straight ahead (this is actually very key to the success of the exercise). Lower yourself as low into the lunge as you can while maintaining good balance and knee stability. Once you’ve reached the bottom of your range push back up driving hard through the lunged leg back to a standing position and putting the lunged foot down where it started. Do this with the same 2 to 3 sets of 10-12 reps as you did with the squats making sure to work both legs either one leg at a time or alternating side to side in the same set.
3. Donkey Kicks: Starting on the floor with your weight on your hands and knees in the “on all fours” position. While keeping a straight and flat back lift one leg up off the floor and bring the knee forward towards your chest keeping it straight and in line with the hip. Your knee may want to waver in or out depending on which part of your hip complex is weak or tight but the key is to keep the leg moving in a straight line. After bringing your knee forward you want to extend the leg back and out away from your body as if you were kicking something. The goal is to reach back as far and as straight as you can with your leg while purposely trying to contract the glute. It will also add a little extra to the move to point the toe at the end of the motion. Hold the position for a second or two and then return the knee back to the floor. Do this for 2 to 3 sets of 10-12 reps. Feel free to alternate legs through the set or do each leg’s set fully before doing the other leg as this will make no difference on the effectiveness of the exercise.
Beyond strengthening you will want to make sure you incorporate good and focused stretching of the hip complex to your routine. There are many different stretches and options that include practices like Yoga and foam rolling.
A final piece of advice for IT Band pain is directed to the practice of foam rolling. Many information outlets will tell you to foam roll directly over and down the length of the IT Band to release it. This is often a very painful practice and is one that I steer my clients away from as it is a poor practice. The IT Band is a giant piece of connective tissue that will not respond to foam rolling the way a muscle does. In fact it really won’t respond to this action at all except to offer you pain. Foam rolling directly over the IT Band can also exacerbate and perpetuate inflammation which will only prolong your It Band issues. The key is to focus your stretching and foam rolling on the muscles connected to and around the IT Band as these are the causes of the band’s tightness. Sticking to the softer and more responsive muscle tissue will help eliminate the pains much quicker and it’s a much more painless experience.
IT Band pain can be very frustrating and very painful. The best course of action is to take some time off from the running, cycling, heavy weight training, or whatever else you might be doing to cause the problem and give the muscles a little break while also giving them some corrective and therapeutic attention. Be patient and focus on the problem from the right angle and you should be pain free in no time.