Problems with the iliotibials are most often caused by tight knotty muscles around the hip, which can result in an intense pain at the side of the knee where the ITB band is found. But rather than starting here, the problem is often the result of tightness in the low back/torso which is caused by tightness and knottiness in the upper back. In Hong Kong professionals this is most commonly a result of prolonged sitting, poor posture and stress. Many people try to loosen their ITBs by means of a foam roller but without success. I’m not saying that the foam roller is useless but you will never get long-term results unless these other issues are addressed.
Runners may first notice the problem on the outside of their knees because the ITBs cross the knees. If the ITBs are tight they cause excessive friction, called ITB friction syndrome. Do you twist on squats or deadlifts? The problem is more likely to show up under fatigue, often on the last repetition. If you have a trainer, get them to have a close look. Even if you don’t feel ITB problems but are twisting incorrectly you are setting yourself up to develop problems.
Check and see if the muscles around one hip are tighter than they are on the other hip. You can also check with step-ups and single leg squats, looking at right versus left. If your pelvis drops more on one side than the other then you have this problem. Do the test in front of a mirror and/or have your trainer watch. Of course these exercises might not show up a problem because the tightness and knottiness could be equal on both sides. In general, however, we don’t sit perfectly straight so the problem usually shows up more on one side than the other. Can’t feel any knottiness around your hip muscles? Come and see me and I will find it.
Exercise and/or stretching alone is not sufficient to solve the problem. The solution will be found in deep tissue work in addition to exercise and stretching. You may think that you just have to concentrate harder on doing these exercises evenly and stop before the twist starts etc. but that doesn’t work. All that will happen is the better side will respond more to exercise and stretching and the knottier side less so, which simply worsens the imbalance. The better side gets more of that nice ‘next day’ soreness in the middle of the muscle that stimulates it to improve but the bad side, which needs improvement, doesn’t get it.
If in your frustration you increase the frequency of exercise, the knottier side is more likely to get excessively inflamed at its attachment points to the bones. Deep tissue work can specifically target these knots. This makes exercise and stretching more efficient and effective and in turn the exercise and stretching makes the deep tissue work more efficient and effective. This is one reason why physiotherapy and massage therapy are closely associated with sport and why athletes get bodywork done, whether they are injured or not. If you want long-term results and progress – not just repeated temporary relief – then book an appointment to see me.
