Rolling your IT band is getting you nowhere
“Runner’s knee” is a common phrase used around the running community and is often correlated with a sensation of tightness on the outside of the leg and pain on the outside of the knee. The Iliotibial (IT) band is the commonly accused culprit for this condition, and the most common do-it-yourself approach to fixing this problem is using a foam roller on the painful leg.
Because foam rollers have been shown in the literature, at least initially, to increase range of motion and reduce pain in muscles, it’s a reasonable approach. However, the IT band is not muscle, it’s what’s called fascia, and it reacts differently.
The IT band has deep attachments to the femur (the long thigh bone) and is very strong, but not very elastic. It’s so strong in fact, that you, or any manual therapist, will never be able to “lengthen” this tissue. However, a therapist can improve tissue movement at the junction between different hip and leg muscles which the IT band crosses, but the ‘shearing force’ required to make improvements can’t be done with the foam roller. And finally, the IT band is almost always being over stressed already, or over stretched if you will. You're better off staying away from the actual site of pain aside from maybe ice.
Foam rolling the muscles around the IT band in the quads, hamstrings, and calf will assist in improving the condition, but it’s an incomplete approach at best. This condition is not typically a knee issue. It’s a hip, foot, or core issue, so try this instead.
Roll the foot comfortably on a ball to ensure the joints of the foot are getting good movement, and make sure the big toe is sufficiently mobile. While weight bearing, you should be able to pull your big toe off the ground with ease to about 60 degrees of extension. You can also simply spend time out of your shoes on a natural surface which will “wake up” the tiny support muscles in the foot. Without a mobile foot, especially in the big toe, you will likely have less activation of the gluteal muscles which help stabilize the hip and therefore, has a huge effect on the knee.
For the hip, you need quality extension and internal rotation. Most people have very poor hip extension, and when they get into what appears to be hip extension (think of your back leg on push off), they arch in the low back creating a focused area of extension in the small of their back which will lead to joint and muscle pain of the lower spine/SI joints. Performing a good hip stretch followed by active hip range of motion will provide better joint motion over time. For a few good stretches for the hip YouTube the following phrases: “Bretzel 2.0” and “tactical frog”. For an example of active hip motion I’ve posted a video on ChiroStrength’s Instagram page.
Also, staying with the hip and core, you need to have good balance. Runners spend up to 95% of their race on one leg, however, most people don’t train any one legged exercises. A little more advanced, but fantastic exercise, is the single leg dead lift (with or without weight). This is a challenging exercise when a focus is put on maintaining a neutral spine and good hip extension on the up leg. And because we are bipedal creatures (walk on 2 legs), we must train more transverse plane core exercises instead of frontal plane exercises. That simply means, core exercises need to be focused on controlling or resisting rotational forces, (think Chops, Lifts, or Pallof Presses) instead of frontal plan exercises like planks, sit ups, or leg raises. A core that can properly handle the rotational force associated with throwing the right leg and left arm out in front of the body, for example, will be better able to support the lumbar spine, pelvis, and hips thereby saving the stress on the knees.
When these areas are ignored in a runner’s routine, you’ll commonly see them land on a knee that cave’s in, which stresses the IT band. Not because the knee is somehow functioning improperly, but the support system is failing. Runner’s knee is almost always a mix between stability and mobility problems, so if you want to foam roll the painful leg, follow it up with some quality stability routines or be prepared to deal with this issue for a long time.
Dr. Scott Dunaway is owner and Chiropractor at ChiroStrength Located in Clarksville TN. This facility combines corrective treatment with group classes in order to educate clients on how to maintain their bodies regardless of what their sport or hobbies are. Visit www.ChiroStrength.com or call 931-321-1414 to learn more.