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Hi, 

I'm Maximilian, my goal is to help keep the BJJ community injury free.

ITB Pain

Iliotibial Band Syndrome is a condition that presents with pain on the other aspect of the knee. When pressure is applied there is usually localized tenderness about 3cm upward from the outside of the knee joint, often this is worst when the knee is flexed between 30-40 degrees.  There can also sometimes be an accompanying squeaking or popping sound when the knee moves from flexion-extension.

Usually ITB syndrome is associated with runners and cyclists, however in BJJ I have seen it associated with the use of the hooks such as in butterfly guard. The ITB is a thick sturdy band of fascia that has the role of stabilizing the knee and hip joints. There are a few muscles that have attachments onto the ITB such as the gluteus maximus, gluteus medius, vastus lateralis (quadriceps), tensor fascia latae and biceps femoris (hamstrings). When there is excessive tension pulling from these muscles such as when they become tight, it can place excessive tension onto the ITB and cause irritation to the structures around the knee from compression and friction.

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There are few structures around the knee that can become irritated due to the ITB. The iliotibial tendon itself can become irritated due to compression and friction of rubbing against the bony femoral condyle, also the bursa and/or the fat pad beneath the ITB can become compressed and painful as well. 

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The goal of treatments is primarily to release tension off of the ITB so that the compression placed onto the underlying deeper structures such as the bone, fat pad and bursa is reduced. An interesting 2017 study by Wilhelm has shown that the entire iliotibial tensor fascia latae complex is capable of being stretched by approximately 2.3% percent through simulated clinical stretching. Of the different parts of the ITB, the proximal aspect (closest to the hip) was the most receptive to stretching followed by the distal portion (closest to the knee) while the middle responded the least. Although the ITB can be stretched, it remains uncertain whether or not the effects of stretching it are long lasting.

 The greatest benefits shown for lengthening the ITB TFL complex have been shown by the middle image which stretched increased the overall length by 11.15%.  3 sets of 30 seconds was used.  (Fredericson  2002) *Note: this stretch will also affect the gluteus medius. 

The greatest benefits shown for lengthening the ITB TFL complex have been shown by the middle image which stretched increased the overall length by 11.15%.  3 sets of 30 seconds was used.  (Fredericson  2002)
*Note: this stretch will also affect the gluteus medius. 

In the past it has been common to suggest hip abductor strengthening exercise for ITB syndrome, however lately this appears somewhat controversial. The theory is that an underactive gluteus medius muscle (hip external rotator) will result in over-recruitment of the TFL (hip internal rotator) as a compensation which will lead to increased hip adduction and internal rotation making the ITB more likely to impinge the structures of the knee. Basically gluteus medius strengthening appears to work for some groups but not others, it most likely depends on the individual and whether or not that muscle lacks strength, endurance or activation. 


Foam rolling and lacross balls are both useful tools that can be used to help manage ITB syndrome. With foam rolling, the current popular opinion is to focus on the attachments of the muscles and the muscle bellies rather than the ITB itself, this is because the muscle tissue is more responsive to stretching and release techniques.  Some common methods to release tension on the ITB are listed below.

 Foam Rolling for the vastus lateralis attachments.

Foam Rolling for the vastus lateralis attachments.

 Using a firm ball (any kind of firm ball) to release myofascial tension of the hamstrings. 

Using a firm ball (any kind of firm ball) to release myofascial tension of the hamstrings. 

Stretching the muscles that attach to the ITB are often useful as well. Here are some common techniques listed below. 

 Gluteus medius stretch

Gluteus medius stretch

 Quadricep stretch

Quadricep stretch


Like most musculoskeletal conditions, there is normally a build up of a few different events that leads to the problem. Since there are numerous causes of ITB syndrome, there are consequently numerous solutions. Some treatment options will work better for certain types of presentations, while others might find relief elsewhere. The main point to drive home is to try out the different options and see what works for you. 

 



References:

Muhle C, Ahn JM, Yeh L, Bergman GA, Boutin RD, Schweitzer M, Jacobson JA, Haghighi P, Trudell DJ, Resnick D (1999), ‘Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees’.Radiology. 212(1):103-10.

Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Dec 1;19(12):728-36.

Grau S, Krauss I, Maiwald C, Best R, Horstmann T. Hip abductor weakness is not the cause for iliotibial band syndrome. International journal of sports medicine. 2008 Jul;29(07):579-83.

Nath J. Effect of hip abductor strengthening among non-professional cyclists with iliotibial band friction syndrome. Int J Physiother Res. 2015 Feb 1;3(1):894-904.

Williams DJ. Examination of hip abductor strength in collegiate track athletes with iliotibial band syndrome (Doctoral dissertation, Utah State University, Department of Health, Physical Education and Recreation).

Mucha MD, Caldwell W, Schlueter EL, Walters C, Hassen A. Hip abductor strength and lower extremity running related injury in distance runners: A systematic review. Journal of science and medicine in sport. 2017 Apr 1;20(4):349-55.

Wilhelm, M., Matthijs, O., Browne, K., Seeber, G., Matthijs, A., Sizer, P. S., … Gilbert, K. K. (2017). DEFORMATION RESPONSE OF THE ILIOTIBIAL BAND-TENSOR FASCIA LATA COMPLEX TO CLINICAL-GRADE LONGITUDINAL TENSION LOADING IN-VITRO. International Journal of Sports Physical Therapy12(1), 16–24.

Souza TA. (2016)Differential diagnosis and management for the chiropractor: protocols and algorithms. Jones & Bartlett Publishers; fifth edition.

Fredericson M, White JJ, MacMahon JM, Andriacchi TP. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Archives of physical medicine and rehabilitation. 2002 May 1;83(5):589-92.

Kim BB, Cynn HS, Lee JH, Choi WJ, Jeong HJ. Iliotibial Band Stretching With and Without Manual Patellar Stabilization in Subjects With Iliotibial Band Shortness. Archives of Physical Medicine and Rehabilitation. 2016 Dec 1;97(12):e25.

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