Massage for Hip Pain

What Is Iliotibial Band (IT Band) Syndrome?


The iliotibial band (IT band) is a thick band of fibers that begins at the iliac crest (the border of the most prominent bone of the pelvis) in the pelvis and runs on the lateral or outside part of the thigh until it attaches to the tibia (shinbone). The gluteal or buttock muscle fibers and the tensor fascia latae (muscles of the hip joint) attach to it, and the band acts to coordinate muscle function and stabilize the knee during running.

Iliotibial band syndrome describes the pain caused by inflammation of the band as it crosses the lateral femoral epicondyle. When the leg is in a straight (known as extended) position, the band fibers are anterior to, or in front of, the condyle (a bony projection on the outer surface of the femur, or thigh bone). As the knee flexes, the fibers move across the lateral femoral epicondyle and are positioned behind or posterior to it. A bursa or sac in this area allows the IT band to glide over the end of the femur.

When the band becomes irritated, friction may occur with walking or running, causing lateral knee pain due to inflammation on the side of the knee joint.

If symptoms are ignored, further inflammation and scarring may occur in the bursa, causing progressive knee pain with decreased activity.

What Causes IT Band Syndrome?

Inflammation of the IT band occurs because of overuse and is most often seen in a marathon or other long-distance runners. Commonly, mechanical issues with poor flexibility and decreased strength in the quadriceps muscles of the thigh lead to inflammation.

Factors such as leg length discrepancy, an abnormal pelvic tilt, and “bowlegs” (genu varum: genu=knee + varum=angles in) may cause iliotibial band syndrome because of excessive stretching of the IT band across the femoral condyle.

Training errors in long-distance runners (for example, running on one side of the road only) may also cause symptoms. Since most roads are higher in the center and slope toward the edge, running on only one side will cause one leg to always be downhill from the other. Runners who fail to recognize this issue are at risk to develop inflammation of the iliotibial band.

Because of the mechanics of running, in contrast to long-distance runners, sprinters tend not to develop this syndrome, but tennis players and bicyclists may.

What Are the Symptoms of an IT Band Injury?

Lateral knee pain is the primary symptom due to inflammation as the IT band slides across the femoral epicondyle on the outside of the knee. Pain is most severe with the heel strike of walking or running and may radiate from the knee up the leg to the hip, causing hip pain. Pain may also be felt with knee flexing, especially going up or down steps.

Physical examination may reveal general tenderness over the site of the iliotibial band insertion at the knee joint, and specific tender points may be felt over the lateral femoral condyle where the bursa is located. The examination may find some weakness or imbalance of the quadriceps muscles (those in front of the thigh that extends the knee) and the hamstring muscles located in the back of the thigh that flex the knee.

The iliotibial band may also be tight. Its flexibility can be determined by the health care provider as the patient is taken through a variety of stretches. The Thomas test and the Ober test are the names of two maneuvers that may be helpful in assessing the flexibility of the tensor fascia latae, the gluteal muscles, and the iliotibial band.

What is Deep Tissue Massage and what to expect?

Deep tissue massage is a massage that is designed to get into the connective tissue of the body, rather than just the surface muscles. As a massage therapist when I perform deep tissue I use a variety of techniques to deeply penetrate the muscles and fascia, loosening them and releasing tension. Most clients have a more intense experience with a deep tissue massage, but also feel that it is more beneficial because it addresses deep-seated muscle pains. Deep tissue is beneficial when undertaken on a regular basis so that I can work together with the client to correct long term problems, relax the body, and prevent injury.

To get a truly good deep tissue massage you need to find someone who specializes in deep tissue, like Nicola.  Most spas have several massage therapists who can offer a basic deep tissue massage integrating a number of techniques and styles customized for your body for maximum impact. Experiment by trying several deep tissue massage therapists to find the one that is the right fit for you and your body.

One of the defining differences between deep tissue and regular massage is the use of tools. A standard massage usually only involves the hands and lower arms of the therapist. During a deep tissue, however,  I use elbows and fingers for deep, penetrating work in the muscle. A deep tissue massage also tends to be very slow, and I will use long, flowing strokes to ease in and out of the muscle. Going in too quickly can cause the muscle to tense up, which is not the desired reaction. I also maintain firm pressure at trouble spots for several minutes to achieve muscle release before moving on to the next area of the body.

Deep tissue massage is designed to relieve severe tension in the muscle and the connective tissue or fascia. This type of massage focuses on the muscles located below the surface of the top muscles. Deep tissue massage is often recommended for individuals who experience consistent pain, are involved in heavy physical activity, such as athletes, and patients who have sustained physical injury. It is also not uncommon for receivers of Deep Tissue Massage to have their pain replaced with a new muscle ache for a day or two. Deep tissue work varies greatly. What one calls deep tissue another will call light. When receiving deep tissue work it is important to communicate what you are feeling.

When you go to get a deep tissue massage, you should talk with the therapist about any issues you might have and like to see addressed during your massage. I am happy to concentrate on a single body part for an entire massage to achieve lasting results and in fact, half of my clients want just that! It is also important to communicate with me about pain; The massage may be intense, but if a client starts to feel pain, he or she should communicate that immediately. I work on a scale of 1 – 10, where 7 is on your comfortability edge for that day and 10 is very uncomfortable pain. A lot of my clients take the deep tissue pain or even like the pain in order to get the quickest results for their body type.  At the end of the session, lots of water should be consumed to help the body express the toxins released during the massage. You will probably be sore for a few days after the intense deep tissue treatment but that’s normal. Remember that ice is your friend.

What Are Medications and Treatment Options for IT Band Syndrome?

Aside from pain control with anti-inflammatory medications, treatment alternatives tend to be recommended in a stepwise approach.

Physical therapy may be a viable treatment option for many patients with iliotibial band syndrome. The therapist may wish to assess the running technique and style to look for an underlying biomechanical cause of iliotibial band inflammation. This may include gait analysis as well as flexibility and muscle strength assessment.

  • The therapist may be able to recommend proper shoes or an orthotic shoe insert to help correct any imbalances or abnormalities.
  • The therapist may teach specific stretches to loosen tight structures.
  • In treating the acute injury, photopheresis (a technique in which ultrasound is used to propel anti-inflammatory or corticosteroid medications through the skin into the inflamed tissue) or iontophoresis (an electric charge is used instead of ultrasound to deliver the medications through the skin) may be considered.

If rest, ice, and physical therapy fail to resolve the ITBS inflammation, the health care provider may consider a corticosteroid injection into the inflamed area.

Finally, if all else fails, surgical options do exist for ITBS. An orthopedic surgeon, using an arthroscope, may be able to break down the scarring surrounding the iliotibial band. If needed, the band can also be lengthened to decrease the stretch and subsequent potential for irritation and inflammation as it crosses the femoral condyle.

What Is the Follow-up for Iliotibial Band Syndrome?

As with any overuse injury, once the first episode is resolved, it is important for the patient to assess why the iliotibial band became inflamed in the first place. Recommendations from the physical therapist regarding training techniques, footwear options, the need for orthotics, and proper stretching will be helpful in preventing the recurrence of symptoms.

Ideally, the goal for the patient will be to return to the level of activity enjoyed prior to the injury.

How Can I Prevent Iliotibial Band Syndrome?

The most common cause of iliotibial band syndrome is running. Prevention opportunities include the use of proper footwear, adequate stretching after running, and being aware of training mistakes, especially running in the same direction on a track or on the same side of the road.

Pro Massage by Nicola, LMT Specializing in Sports Injuries, Santa Barbara, Goleta, Ca.
Pro Massage by Nicola, LMT Specializing in Sports Injuries, Santa Barbara, Goleta, Ca.

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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