Chronic knee and hip pain can affect anyone, from long-distance runners and cyclists to sedentary office workers. But not all joint pain originates in the joint. When the iliotibial (IT) band — the tough connective tissue that runs along the long leg bone between the knee and hip — is under stress, it can rub along the femur and cause tightness and pain in the knee, leg, hip or buttocks.
Symptoms of iliotibial band syndrome (ITBS) include:
- Pain on the outside of the knee
- Pain along the outside of the femur
- Tightness or pain in the hip and buttocks
- Increased pain when the knee is slightly bent
ITBS is one of the most common causes of knee pain, and accounts for more than 1 in 10 running injuries and nearly 1 in 4 cycling injuries. Women are twice as likely as men to develop ITBS, which may be due to a wider hip-to-knee ratio.
A number of factors can trigger IT band tightness, including:
- Skeletal structure, including wider hips ("Q angle"); an in-turn gait (pigeon toe); and leg length difference, all of which increase stress on the IT band.
- Training errors such as increasing mileage or intensity too quickly.
- Biomechanical problems, such as muscle weakness or poor body coordination.
- Insufficient shoe support, especially when running.
- Insufficient warming up before exercise.
- Prolonged sitting: Sitting for a long period with the knee in the flexed position can aggravate the IT band and cause pain. It is because anytime the knee is flexed about 20 to 30 degrees, the IT band is most at risk of compressing on the bony bit of the thigh bone.
Gentle stretching and conditioning is also helpful in loosening tight IT bands. Olga Hays, an American Council on Exercise-approved trainer and wellness promotion specialist with Sharp Best Health, Sharp's employee wellness program, offers these simple exercises to relieve IT band pain and build muscle strength.
IT band stretches
"IT band stretches can make a big difference for leg, hip and knee problems, and help relieve pain in these areas," says Hays. "To be effective, you need to hold each of these stretches for 30 seconds, and repeat them three times."
Basic IT band stretch
Stand near a wall or piece of furniture or equipment for support, if needed. Cross the right leg over the left leg at the ankle, keeping legs together. Reach your right arm over your head and lean to the left, holding for 30 seconds. Repeat with the left leg over the right.
Seated IT band stretch
This is a great daily stretch for people who spend much of their day seated. Sit with your back straight and knees at a 90-degree angle. Place your right leg on top of your left leg, with the right ankle resting on the left knee. Lean forward, pressing down on the leg. Repeat with the left leg.
"Most IT band problems stem from a weakness in the glutes and hip area," says Hays. "Strengthening muscles in these areas with a series of exercises is a necessary part of any ITBS treatment."
Perform the exercises in a row with 30 to 60 seconds rest in between (rest longer if needed).
Side leg raise (20 to 30 per leg)
Lie on your right side with legs together. Tighten your abdominal muscles and lift up the left leg, keeping your hips aligned and leg straight. Slowly bring down the leg, and repeat 20 to 30 times. Switch to your left side and repeat. For additional resistance, loop an exercise band around your ankles.
Clamshell (20 to 30 per leg)
This is similar to the side leg raise, but with the knees bent and the heels in line with the buttocks. Keeping your ankles together, lift up the upper leg, rotating the hip out, and then back together slowly. Repeat 20 to 30 times and then switch sides.
Hip Thrusts (20 to 30)
Lie on your back with your weight on your upper back (between the shoulder blades and your feet). Keep your arms at your sides or cross them over your chest. Lower your butt almost to the ground and thrust upward by activating your glutes and driving your heels into the ground. Repeat 20 to 30 times.
Most people with ITBS find relief with stretching and conditioning; anti-inflammatory medications such as ibuprofen or acetaminophen; ice; and rest. However, chronic IT band pain may require the help of a trainer or physical therapist to improve range of motion and build muscle strength in the glutes and hip area. Talk with your doctor to see what course of treatment is best for you.