Is lateral knee pain caused by a tight IT band?

At the beginning of every restorative class I teach, I ask, “Are there any body part requests?” Without fail, someone will always request that we foam roll the IT band to help his or her achy/tight hip or knee. While I’m happy to oblige, I do think it is worth explaining that there is more to the story.

I get why the IT band comes up. Anyone who has ever had hip, back or lateral knee pain has probably been told that part of the reason why they hurt is because their IT band is tight. Knowing that, an obvious solution is to roll it out.

This is fine. No one ever died from rolling their IT band and the thing is as tough as sheet metal, so you’d be hard pressed to injure it. However, my question is what is happening in the system that is making the IT band feel so tight and what approach is going to be most effective for addressing the areas of pain?

To understand why your IT band feels tight, you need to understand what else is happening in the hip and leg. The first thing to consider is the general anatomy that region.

This is oversimplified, but on the outside of your leg, you have your IT band. Your IT band isn’t a muscle. It’s a super strong, dense band of connective tissue that is responsible for stabilizing the outer hip and knee.

Above the IT band is a relatively small muscle called your tensor fasciae latae or TFL. The TFL is attached to the IT band and is responsible for ABducting the hip (i.e. moving the leg away from the body) and for internally rotating the thigh.

Towards the back of your pelvis is your gluteus medius or glute med. The glute med has multiple fiber directions that allow it to perform different actions. All of the fibers will ABduct the hip, but more specifically the anterior fibers of the glute med will work with the TFL to flex the hip and internally rotate the thigh. The posterior fibers, which are the ones I’m more concerned with today, will extend the hip and externally rotate the thigh.

Towards the front of your leg is the vastus lateralis or your outermost quad muscle. The vastus lateralis is mostly responsible for knee extension. However, because it lies underneath the IT band and attaches to the outside edge of the knee cap and on the backside of the leg, it has a lot of (literal) pull when it comes to the tracking of the hip and knee.

Photo Credit: Shutterstock

On the inside of the leg is the adductor group or your inner thigh muscles, which you can think of as the bookend to the ABductors that I described above. This is a group of 5 muscles that are responsible for internally rotating and ADducting the thigh. (Note, ADduction means to pull something closer to the midline).

Assuming that our alignment is good, all of these muscles will do their jobs, the outer and inner musculature will remain in balance and our knees and hips will track appropriately. However, many of us are walking around with tight IT bands, misaligned knees and achy hips, so clearly this isn’t happening.

So what’s going on?

I’ll start with this. I don’t think the IT band, which is a sheet of contractile tissue, can be solely responsible, where there are so many other muscles surrounding it.

As a whole, we are a sitting society, which means we spend a lot of time with our hips flexed. When we hold static postures for long periods of time, our tissues will change length to better hold that posture. In the case of sitting, this means many of us will be biased towards flexed hips that don’t stabilize well.

Here’s how this translates to standing and walking. Once we stand, we no longer have the same access to hip extension, which means it is much harder for us to access our glutes, which respond to hip extension. At the same time, it makes us more likely to overuse our hip flexors and quadriceps – particularly the more lateral quads like the vastus lateralis.

When the front and back of the leg are out of balance, the musculature on the sides of the pelvis will be as well. With a lack of hip extension, the glute med, which in addition to hip extension is responsible for stabilizing the pelvis and resisting internal rotation of the knee, can become inhibited. When this happens, the body will turn to its neighbor the TFL to do the job.

The problem is that while the TFL can stabilize the hip, it doesn’t perform hip extension and it is an internal rotator. As it continues to do the job of the glute med, it will start to pull up on the IT band as a means of offering more lateral support to the unstable hip and knee.

glute_med_activation_Pilates_Seattle

You can literally see the upward pull of the TFL in the first photo with the collapsing in of the foot and inward rotation of the knee. Notice how much straighter the hip, knee and foot are when the glute med is active.

This creates a lot of outward and forward pull on the thigh, so something has to counterbalance this. For many of us, this is where the adductors come in. When the hip is out of balance, the adductors are prone to firing, but not in a functional way. They will essentially take over any additional jobs that muscles of the hip have failed to do and can become locked long, but in a constant state of contraction.

So how will this translate to our movement patterns and what might it feel like?

When we move this way for long enough a few things happen. First, we may feel super tight on the side and front of our hip. If you feel this tightness, there is a good chance that your TFL is telling you that it is exhausted.

We might also feel tightness down the outside of the leg and/or into the outside of the knee. That may be your IT band, which is locked in a shortened position from being constantly pulled up on by the TFL in attempt to stabilize your hip and knee, since your glutes aren’t necessarily doing their job.

However, remember that the vastus lateralis runs under the IT band and attaches on both the front AND the back of the leg, so if you feel tightness down the side of the leg, it might not be your IT band at all and could very well be the vastus.

Still unsure if this is you? Here’s what it might look like in your standing posture.

Massage_Seattle_IT_Band

When you stand, your feet might collapse in or over pronate. Additionally, your knees will have a tendency to fall in or look knock kneed. This is a “classic” posturing for when the muscles on the outside of the leg are locked short and the muscles to the inside of the leg (adductors) are locked long.

What if you have the opposite posture, but your IT band still feels tight?

If you stand with all of your weight on the outside edges of your feet and your knees look bowlegged, then your IT band isn’t tight! It just feels that way; because it is stuck in overstretch. In this case, your adductors are actually what are locked in the shortened position.

So how do we address this?

There are a few ways to go about this, but in my experience a combination of activating the inhibited muscles and using compression techniques on both the locked long and locked short tissues will yield the best results.

Stretches can also be utilized on the short tissues, but if you aren’t sure what is short or long, compression techniques are a safer bet, since they’ll restore the muscle to something closer to its ideal point of tension and you won’t have to worry as much about what is locked short and what is locked long.

To see more specific recommendations, please visit part 2 of this article.

Leave your thought