Pain on the side of the legs or outside of the knees are a common complaint in our Boulder Office. Most of our patients have tried endless (and painful) foam rolling along their IT bands, but feel they can’t maintain any long term relief. Because the IT band is a thick, taught band of connective tissue, it is very difficult to truly “stretch” and roll out. Instead, tightness can often be due to overactive muscles in the front of the hip that are attached to the top of the IT band. One culprit in particular is the muscle called the Tensor Fascia Latae (TFL). The TFL is located in the “front pocket” area of the hip and, because it is a muscle and has more elastic properties than the IT band, we can have greater success addressing this muscle instead of the IT band itself. We’re going to discuss why the TFL and IT band gets tight, what you can begin to do to fix it at home, and some things we can do in the office to help you get back to the activities that you love.
Why does IT band pain happen
At Home self test for IT band pain
At home exercises to relief IT band pain
Treatment we can do in the office to help you get back to 100%
What is IT Band Pain?
Most people feel tightness or pinching in the front of the hip as well as pain at the side of the knees. This can sometimes feel like a deep ache or can be tender to touch or lay on one’s sides. This can be irritation at the IT band often from the TFL being shortened and tight. When a muscle group is shortened, it is no longer in the optimal position to do its job and it can become irritated and cranky. This shortening leads to a hip that is biased into a flexed position, altering the hip mechanics for daily activities such as walking or climbing stairs, as well as recreational activities such as running or hiking.
Why Does IT Band Pain Happen?
TFL and IT band tightness can often be caused by the perfect storm of prolonged posturing and undertraining the opposite side of our hip: our glutes. Most patients sit for a majority of the day. They sit to commute to work, sit at a desk, and when work is done, they go for a hike, run, or ride their bike. With consistent tightness in the front of the hip, we tend to develop compensatory patterns and our body gets used to recruiting these muscles instead of our largest stabilizing muscle groups of the hip which are the glutes. Without intentionally working to undo this bias by loosening the front of the hip (TFL) and then strengthening the back of the hip (glutes), we stay in this cycle of tightness and over-recruitment of non-optimal muscles. When the TFL remains tight, it tugs on the top of the IT band which can have a painful effect all the way down the side of the leg.
Tightness or Weakness?
A question that often comes up is, “Are these muscles tight or are they weak?” Often these two go hand and hand. Both overuse and underuse can lead to tightness. It doesn’t take long before the tightness or tissue contraction promotes trigger point development which leads to pain. Pain is a great inhibitor of muscle function which can lead to decreased strength on all sides of the hip. Stretching can be useful for pain relief, but unless we’re strengthening to “undo” our body’s known movement patterns, stretching will only be a temporary modality.
Self tests for IT Band tightness
There are three tests you can use at home to identify tightness in the front of the hip and weakness in the glutes.
Thomas Test:
In this test, start by sitting on the edge of a table. Put your hands around one knee and roll backwards to lay flat on the table while completely relaxing the other leg. If your leg does not lay flat on the table or hangs out to the side, it is likely due to a muscle at the front of the hip being tight.
Single Leg Squat Test:
In this test, you want to start in front of a mirror to assess form. Standing on a single leg, complete 5 consecutive single leg squats to whatever depth feels comfortable for you. In the mirror you are looking to see if your knee starts to fall towards the center of the body, which often indicates glute weakness.
Bridge March Test:
In this test, you’re going to begin by lying on your back. Bend up both knees to a comfortable position and then lift the hips up into a bridge. Keeping your hips lifted, lift one foot off the ground and see if you can maintain level hips or if the lifted side dips towards the floor. Alternate sides and assess any “dipping” on the other side. If you have a hard time maintaining level hips, this is most likely due to glute weakness.
At home exercises for IT Band Pain
Self massage the TFL Muscle
Using a lacrosse ball, place the ball onto the “front pocket” area of the affected hip (see image above for reference) and lean against it on the wall. Instead of rolling the ball around, sustain pressure on a tender spot for 20-30 second holds. You should feel the discomfort decrease on the tender spot as you hold - this is the “release” of a trigger point. Continue on 3-5 tender spots or as needed. Avoid bony spots or spots that seem to worsen with pressure.
At home Glute Strengthening Exercise
Glute Bridge
Start by lying on your back and your knees bent up to a comfortable position. Begin by engaging your core: draw navel up and in in order to flatten your back to the surface. Then squeeze both glutes and lift the hips only about 6 inches from the surface. Avoid lifting so high that you lose core activation and begin arching your back. You should predominantly feel your glutes squeezing without activation from the hamstrings or low back. Start by performing 8-10 repetitions, 2-3 sets until your glutes are fatigued. Take a break if you feel other muscles compensating.
Side Plank on Knees
Prepare by laying on your side with your knees bent. Keeping your knees together, prop up onto your elbow and lift your hips from the surface. Be sure to keep your elbow aligned directly under your shoulder. Engage your core as you did in the hip bridge (drawing naval up and in) and rotate your bottom hip forward and up towards the ceiling until you feel the side of your hip working. Begin with 3, 10-15 sec holds. Form is key, so we would rather have you hold a shorter amount of time with proper form than long holds with compensation.
Chiropractic and Physical Therapy to fix IT Band Pain
If you are suffering from IT band pain, it is likely that you need to have a full evaluation performed by our doctors to identify the weakness and/or limited mobility that triggered your symptoms. In your first appointment you will learn the cause of your symptoms, receive treatment, learn targeted exercises, and have a plan to return to pain free activity. This typically involves hip, core, or glute strengthening, in order to increase hip stability and reduce compensation with activity.
Active Release Technique for IT Band Pain
Active release technique (ART) is a non-invasive, hands-on diagnostic process of evaluating and treating musculoskeletal problems in the body. ART works by releasing tight and inflamed muscles, ligaments, tendons, and fascia after injury and overuse injuries.
ART is a fantastic tool for releasing the tension in the hip, quad, and hamstrings.
Dry Needling for IT Band Pain
Dry Needling is a technique that uses acupuncture needles to release tight, stubborn, muscles quickly. Unlike other hands on techniques, the needle can penetrate deeper into tissues to help manually release the muscle and stimulate a healing response. This can be helpful to facilitate pain relief, but also allow the glutes to tolerate exercise as they are no longer restricted by tight musculature.
If you are looking for IT band pain relief in Boulder, Colorado - schedule an appointment today by calling or email the office.
This article was written by:
Jill Greenfield, DPT, SCS
Sports Clinical Specialist
Boulder Sports Chiropractic
3000 Center Green Dr. #130
Boulder, CO, 80301
ph: 303-444-5105