Illiotibial Band (IT Band) Syndrome
By CEO Robert Forster, PT Lateral knee pain is one of the most common complaints from marathon runners as they build up the mileage in training to above 12-15 miles in preparation for marathon. In most cases, the pain is in one knee and not the other, and this begs the question: why would only one knee hurt if both legs ran the same mileage? The answer, as in all asymmetric overuse injuries, is a mechanical deviation in one or more of the joints of the lower extremity or pelvis on one side or the other. Joint mechanics can be corrupted by an old injury such as an ankle sprain or hamstring strain, or by a pelvic mal-alignment causing a leg-length discrepancy. When the pelvis, which is comprised of two independent large bones call the ilium, is out of line, the joints of the “short” or “long” leg will make adjustments to compensate. The most common compensation is that the foot on the long side will over-pronate as a strategy to flatten the arch and functionally shorten that leg, while the foot on the short side will typically supinate in an attempt to hold that arch up and functionally elongate that leg. These subtle but significant compensations alter joint mechanics and cause aberrant forces to bear down on vulnerable tissues including tendons, ligaments, fascia, and bursa. An effective rehabilitation program must not only treat the painful area but also address the cause of injury by exposing and correcting the mechanical imbalance creating the excessive forces to bear down on the inured structure. Anatomy and Function