I’ve been struggling with iliotibial band (ITB) syndrome. It hurts while standing; I’m only pain-free while sleeping. I have quit running and cycling as they cause too much pain. I’ve had a 3D gait analysis completed at my local running injury clinic and have followed their advice and recommendations.
I have completed months of physical therapy and have tried massage, stretching, dry needling, Active Release Therapy, and hip stabilizing exercises. All therapies provide a few days of improvement only to revert back to burning pain. I am at a loss. I would like to run again! But my first goal is to be pain-free walking, sitting, and standing.
Iliotibial band (ITB) syndrome can be a difficult problem to manage and cure. The ITB is a fascial band of tissue that originates as the tensor fascia latae muscle that merges into the ITB as it courses down the side of the leg and inserts on the lateral tibial platuae (Gerdy’s Tubercle). The tissue is very tough and difficult to stretch, if it can be stretched at all. Most of the pain is usually located over the femoral condyle—just above the knee joint line.
There is some controversy over the origin of the pain and the management plan. Some feel the tissue is tight and is rubbing across the femoral condyle, causing friction pain. Others feel it’s caused by compression of the underlying bursa and other structures. In either case, the functional length of the ITB is what causes the discomfort, and that depends on the positioning of the origin and insertion.
In my general experience with this problem, the root cause has been a combination of abnormal rotation of the pelvis (SI joint dysfunction) and weakness of the pelvic stabilizing muscles. Manual therapy to correct the alignment of the pelvis often relieves the pain and restores the normal muscle function in the pelvic stabilizing muscles. A physical therapist, chiropractor, or osteopathic physician may be able to help you.
There is always the possibility that the initial diagnosis is not correct. Sometimes the initial diagnosis will bias future encounters, and the evaluation suffers the bias of the earlier findings. It may be worth having another evaluation starting with “my knee hurts here” rather than “I have ITB syndrome that has not healed.” The other alternative is to start with a good manual therapist to see if some part of your kinetic chain is not functioning up to par.
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