Knee/hip pain? Could it be IT band syndrome?

By: Mike Donikian, USAT Certified Coach, NASM-CPT

As the weather gets warmer, I've been hearing this concern/question a lot lately. It comes in many different forms:

• "What do I do for knee or hip pain?"
• "What do I do for IT band syndrome? (ITBS)"
• "The outside of my knee hurts and it hurts while running but not cycling"
• "It hurts for running AND cycling"
  
• "What does it mean if my knee/hip hurts but my MRI shows nothing?"

If you have some of these symptoms, I wouldn't rule out ITBS. The iliotibial band (IT band) is a tendon that runs along the outside of your thigh. It originates at the hip and inserts at the top of the tibia (lower leg). I also find that knee pain is also overdiagnosed as ITBS so please make sure you see a specialist and try to not self-diagnose either. This is not meant to be medical advice -- I'm not qualified to do that especially through a blog :)

Anyway, let's assume you've been checked out and have ITBS. You can certainly do some foam rolling (http://www.tptherapy.com) to try and get rid of it but depending on the severity you'll only get some temporary relief. I like to attack the root cause which tends to be a weak gluteus medius muscle. Without getting overly technical, one of the roles of the glute med is to keep your leg "aligned" when your foot makes contact with the ground during the support phase of your run. A weak glute med will cause your leg and knee to adduct (come inward) and can stress the IT band to the point where it becomes irritated, inflamed, and excruciatingly painful.

The plan of attack it to strengthen that glute med. One of the things you'll actually want to avoid is stretching that glute med as chances are it's "overstretched". I'm talking about that stretch where you cross your leg on top of your knee in "figure-4" pattern. Yeah I know it "feels like it's a good stretch" but chances are it's just causing more trauma. Yes, I'll repeat that: "stretching can actually make an injury worse!" Stretching the glute med to solve ITBS is like using a hammer to remove a screw... it's not the right tool. I'd say there are equally as many "bad stretches" as there are good stretches... frightening isn't it?

The most basic of glute med strengthening exercises is the hip hike. Start by standing on one leg or by standing with one leg on slightly raised surface like a step while not allowing the other leg to touch the ground. Pick the leg that is the same side as the hip/knee pain. Then raise the opposite hip while supporting yourself on that one leg. Keep your shoulders level. Continue to raise and lower the hip allowing the "dangling" leg to move up and down while you support yourself on the other leg. After a few repetitions you should feel some fatigue. Try the other side and you may notice that it doesn't fatigue as quickly. That's a good indicator that you've found the underlying cause. Perform 3 sets of 15-20 on the affected side at least twice a week and you may find that the pain is gone. Oh yeah and no more of that cross legged hip stretch either.

With the hip hike alone, some people have seen results in as little as one week. Some people may need to work with a personal trainer or physical therapist to do some more advanced exercises and stretches. You may also need to change the way you sit at your desk or in your car. Minor lifestyle habits can result in major injury when you combine it with the stress of a training program. If you haven't already, definitely get yourself checked out.