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IT Band Friction Syndrome – When Knee Pain Comes From the Hip

 

What is the IT Band?

The iliotibial band (IT band) is a very thick, fibrous band of tissue that runs from the outside of your hip down the outside of your leg and connects on the outside of your knee.  Your glutes, hip abductor and tensor fasciae latae (TFL) muscles all connect into this band.

 

leg image

What is IT Band Friction Syndrome (ITBFS)?

A sudden increase in mileage (over a 5% increase in one week) or excessive downhill running can cause the IT band to rub and create friction on the outside of the knee creating pain.  Since the IT band has fibers that also connects into the outside portion of the kneecap this can also be a source of pain at the front of the knee.

What Causes ITBFS?

Remember Newton’s 3rd Law of motion that “every action has an equal & opposite reaction?”  During running, every time our foot hits the ground with a certain amount of force the same amount of force is also exerted from the ground back up through our foot and into our leg.  If the musculature involved (usually the muscles on the outside of the hip) cannot contend with these increased impact and force requirements, then the body can start to break down and often times this occurs at the knee.  A rapid increase in running distance, downhill running, or running on slanted or graded surfaces (the same side of the road every run) forces the legs to undergo a significant increase in impact and force.

How Do I Fix It?

Decreasing your mileage temporarily until your symptoms subside then increasing more gradually sometimes can help initially.  Increasing your cadence (steps per minute) can help because it decreases the time your foot is on the ground, limiting the returning force the ground can exert back.  There is research data to indicate runners with ITBFS may have weaker hip muscle strength on the affected side.  So strengthening those muscles on the outside of your hip is KEY and is very simple with performing either, or both of the following exercises (to be performed every other day at 3 sets of 10 or 15 reps):

exercises

The following stretches after your run will also be helpful to loosen those tissues & muscles on the outside of your hip holding each stretch for 30-45 seconds, 3 times daily:

stretches

HAPPY RUNNING!

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BRET MAIERS, PT, DPT, OCS

Bret Maiers received his Doctorate degree in physical therapy from Eastern Washington University in 2010.  He is a board certified orthopaedic clinical specialist through the American Physical Therapy Association and is currently the clinic director for Mountain Land Physical Therapy at their Stansbury Park location. In his spare time Bret enjoys running and both watching and playing sports.

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Beginner Running Question

Question:

“I just started running…. what do you recommend for me to get started…. as started I mean I ran 2 miles up my road… I had to stop and walk some of it, and my lungs hurt so I think I need to work on my breathing… any advice would help…”

Answer:

We would recommend taking a look at the following articles a few of our Experts have already written. Let us know if you have any further questions.

Getting started: How to Start and Beginning Runner Training
Breathing: Pre-Exercise Ventilation

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Pre-Exercise Ventilation

I thought a short explanation of a typical ventilatory response to the onset of exercise might help answer this question. Carbon dioxide in our blood increases at the onset of exercise at a greater rate than it does later during our exercise bout (after we’ve warmed up for a while). Respiration is what gets rid of this carbon dioxide, and thus our breathing rate also increases more than normal at the beginning of exercise. As exercise progresses, the chemical conditions of our blood (i.e. increased heat & metabolism) allow more oxygen to distribute carbon dioxide out of the blood, creating less demand for our breathing rate to do that.

Read More….

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Runner’s Knee

Expert Panel Question???

“After a run my knee begins to hurt fairly badly. It hurts a little during the run but mainly after. Is there a certain type of shoe that would help with my knees or is the only solution not to run?”

Answer!!!

Knee pain is probably the most common injury complaint in runners and has a variety of causes. The most common, Patellofemoral Syndrome, actually also goes by the lay name “Runner’s Knee”. It is more common in women but can occur in men too. It is characterized by pain in the front of the knee, is worse going up and down stairs, during squats or lunges and often results in a deep ache in the knee after a prolonged knee-bent position (such as sitting in a class, movie, car or on a plane). The fact that your knee pain is not so bad during your runs but afterward makes this the most likely problem although it can get bad enough to become an issue during runs too. It is thought to be an injury that occurs to the under surface of the knee cap (the patella) when the knee cap and the bone below it (the femur) are not in alignment.

The under side of the patella has a small ridge running vertically through the middle of it and the femur below has a corresponding groove. These two should remain lined up as the knee bends and straightens. A misalignment between the patella and the femur can be due to genetic factors, biomechanical problems or the result of muscle imbalances. Since we can’t do much to change our genetics, the focus is on the muscle imbalances and biomechanics. As a one directional sport i.e. straight ahead, even elite runners are notorious for developing muscle imbalances.

Read More….

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Utah Running Expert Answers

Expert Panel Question???

Question: “I have been running pretty consistent for 2 years and now my knees will have slight pain off and on”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

It’s difficult to answer this fully as there are many variables. I’m not sure where your knee pain is located, and under what conditions your knee pain arises? The knees are often the victim to the hip and ankle. Alignment, stride, footwear, core stability and running surface are just a few possibilities. I’d recommend you track more details as to when it occurs related to the run (during, after…), where in the knee it hurts, is there accompanied swelling, and what about other related areas (hip, low back, ankle – same side or opposite)? Possibly stretch after the run and ice your knees; and consider cross training for a change of load to the joints.

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Expert Panel Question???

Question: “I’ve noticed about once or twice a mile I nick my left ankle with my right foot (never the other way around). Is this normal, or do I have a serious problem with my running form?”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

I hear this type of comment often, and it is quite normal especially on uneven terrain. Consider running imagining a 2 inch line in the center. Have the inside arch of each foot touch just outside the line, but don’t cross it or step on it. We often have a dominant leg that tends to be under our center. We want good alignment of the hip, knee and ankle.

Answers provided by:

Korryn Wiese – Physical Therapist, CMPT

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