Don't Blame the Messenger

In my practice and in coaching patients/athletes, whether high school rowers or triathletes, I hear complaints of knee pain, on average, about twice per week. And with the high amount of activity that both of these groups have that is no surprise. What is a surprise is how quickly and commonly these individuals are told to blame their knee pain on a structure that is usually not to blame - the infamous "IT Band". Some do not even really know what their "IT Band" is or does. But somewhere along the way some clinician told them they had the dreaded "IT Band" issues. Usually, they are told, that the culprit is more specifically a tight "IT Band". So this sends most people off to schedule a rolfing session, deep tissue massage appointment, or some other tortuous painful modality. And they very quickly start some pretty crazy looking stretches and rolling around on foam rolls. All of these activities in the name of trying to loosen up this structure that they are not even really sure of how it got so "tight" in the first place...
After the hundreds of painful knee issues that have walked into my clinic over the last 10+ years, I am solidly convinced that the overwhelming majority of them are "killing (in this case actually only 'blaming') the messenger". The messenger being the "IT Band". This structure, more formally known as the Iliotibial tract, is a usually rather innocuous piece of dense connective and ligamentous tissue. It is designed to be a taut connector between the Glutes and Tensor Fasciae Latae (TFL) muscles (located on the anterior-lateral hip) and Gurdy's tubercle (on the anterior-lateral portion of the proximal tibia). It is designed as a leg and knee stabilizer during locomotion. Let me re-iterate something from these last two sentences, the "IT Band" is supposed to be tight and stable. It also has no contractile properties and only serves as a connector between two functional units - the hip/pelvis and the knee. It can be thought of as a sort of messenger of stability and connnection between two others. Hence the "messenger" analogy. The "IT Band" does nothing more than convey biomechanical functionality from the hip/pelvis to the knee. It does not cause anything, let alone knee pain.
The usual cause of knee pain in these individuals that I see are issues in the hip/pelvis that is simply transmitted to the knee through the innocent "IT Band".
If the "IT Band" is functioning in a healthy manner then any issues in the hip/pelvis will be transmitted through the tight and stable nature of the "IT Band" to the knee similar to the tight string between two cups on a kid's homemade telephone.
Further, all the stretching, deep tissue treatment, and rolling around on a foam roller to loosen the "IT Band" is only making matters worse. If the patient/athlete is successful they will indeed loosen the "IT Band" and lessen the symptoms at the knee. But, that only lessens the symptoms. It does not address the source of the issue and/or pain. And invariably once the "IT Band" returns (hopefully) to it's normal healthy operating status, the knee pain will return. This forms a vicious cycle of addressing the symptoms temporarily until they return (which they most likely will) and addressing the symptoms again until they return, etc. etc. etc.
Have you ever wondered why so many people have chronic nagging knee pain from an alleged "IT Band" tightness or issue??? There are many treatments, practitioners, and patients/athletes chasing symptoms around and around without ever addressing the source of the issue.
To review, the "IT Band" is designed to be taut and stable so that force is transmitted from the hip/pelvis down through the leg, knee, and lower leg. If you arbitrarily loosen a tissue that is designed to be tight then you are creating a scenario for more and chronic issues.
The best treatment is to look at the biomechanics of the hip/pelvis and occasionally into the low back and address these issues.
Most of the time, lack of endurance capacity, hip/pelvis flexor (TFL included) hypertonicity, and lack of stability and/or motion into extension of the hip/pelvis are the culprits of "tight IT Band" and associated knee pain.
So please, do not blame, shoot, or kill the messenger (in this case the "IT Band") when addressing an issue. Spend the time to determine the true source of the pain and or issue.
(**For you Shakespeare nerds - this will make Rosenkranz and Guildenstern very happy**)
-DrTri