Are you running into knee pain with exercises?
Many times, runners (and cyclist) have knee pain whenever they are being active. Physicians, physiotherapists, and personal trainers alike attribute this to the Iliotibial Band (ITB) creating friction along the outside of the knee. Their first inclination is to instruct their patients/clients to foam roll their ITB and stretch out the tissue. This couldn’t be further from the appropriate treatment technique. First, anybody who has ever foam roller their ITB can attest that it HURTS LIKE HECK. Secondly, do those treatment options have a discernible impact on the patient.
The anatomy of the ITB is largely misunderstood. John Fairclough, et. al. (2006), provided evidence to support that the tissue that comprises the ITB is comprised of matrices that do not respond to a stretch response. Also, the misconception (one I have held for years) that ITB pain is caused by the anterior-posterior (A-P) translation of the ITB over the distal attachment on the lateral knee is what causes the pain response. In fact, the distal end of the ITB is fixated against an A-P translation. Wait a minute, if there is no shifting of the ITB, then what causes the pain? It is, in fact, actually a compression of a highly innervated fat pad toward the end of the ITB that is what causes pain.
If it is the compression of this fat pad that causes the pain, then wouldn’t logic dictate that foam rolling would further exacerbation the painful stimulus. Many clinicians often overlook the proximal attachments of the ITB complex (i.e., TFL, Glute, Hamstring, Quad) when it comes to treatment. Mark Wilhelm, et. al. (2017) demonstrated that the stretch response of the ITB is seen empirically in the proximal tissue. A research study from 1931 revealed that roughly 2000 pounds per square inch is needed to elicit a SAFE stretch response of the ITB tissue. If you can’t stretch the tissue, then what do you do to treat that lateral knee pain to help your clients return to a pain-free activity.
As a treating clinician, when other potential causes of knee pain are ruled out (i.e., osteoarthritis, acute trauma, patella tendinitis, etc.), you need to start with conservative (non-surgical, non-medication, etc.) treatment. Brandon Jones, MD, et. al. (2015) demonstrates that a combination of myofascial treatment with active stretching and strengthening is the best option to help your athletes return to what they love. Stretching of the adductor (inner thigh) muscle group, in addition to improving hip rotational mobility and enhancing Glute Medius (lateral hip stabilizer) muscle strength and neuromotor control. If you are experiencing pain along the outside of your knee, particularly runners or cyclist, make sure that you find the right practitioner who understands your needs and formulates a treatment plan to best help you reach your goals.
Fairclough, John, et al. “The Functional Anatomy of the Iliotibial Band During Flexion and Extension of the Knee: Implications for Understanding Iliotibial Band Syndrome.” The Journal of Anatomical Society of Great Britain and Ireland, vol. 208, 2006, pp. 309–316.
Jones, Brandon O, et al. “Nonsurgical Management of Knee Pain in Adults.” American Family Physician, vol. 92, no. 10, 15 Nov. 2015, pp. 875–883.
Wilhelm, Mark, et al. “Deformation Response of the Iliotibial Band-Tensor Fascia Lata Complex to Clinical-Grade Longitudinal Tension Loading In-Vitro.” The International Journal of Sports Physical Therapy, vol. 12, no. 1, Feb. 2017, pp. 16–24.