Hip and IT Issues? These Stretches Can Help Your Runs
The iliotibial band—also known as the IT band—is not only one of the most common culprits of knee pain for cyclists, but it also one of the most commonly misunderstood parts of our athletic bodies. If you’re experiencing pain, your first instinct might be to seek out some IT band stretches to alleviate the discomfort, but it’s not that simple. Understanding why the IT band can become a source of pain first requires an understanding of the anatomy.
What is the Iliotibial Band?
The iliotibial (IT) band is a thick, fibrous band of fascia, a type of connective tissue, that extends from the tensor fascia latae or TFL (no, not a Starbucks drink) and gluteus maximus at the hip down to the knee along the outer portion of the thigh. Along the way, it connects the pelvis (iliac crest) to just below the knee (tibia) as its name suggests.
Contrary to popular belief, this band is a connective tissue—not a muscle—so it can’t really be stretched. Bridget Dungan, D.P.T. and triathlete, says that according to current research, you would need a lot of force to stretch the IT band, more than someone could generate on their own.
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If you swear you experience IT band “tightness,” you may be feeling a sensation that’s caused by tightness in the muscles surrounding the hip and IT band. The most common IT band stretch (crossing one leg behind the other and driving the hip out to the side) is more of a tensor fascia latae stretch, which could be helpful if the TFL is tight. Tightness may also result from stiffness of the connective tissue, which can be alleviated by self myofascial release in the form of massage or foam rolling.
If your experience is more painful than the average tight sensation, your IT band may be aggravated, as it crosses over bony prominences, which can cause irritation, pain, or even IT band syndrome.
What is IT Band Syndrome?
IT band syndrome (ITBS) is a condition caused by irritation of the IT band that results in pain along the outside of your thigh, hip, or knee. According to research, IT band pain is highly prevalent in endurance athletes such as cyclists and runners, with over 15 percent of cyclists and 22 percent of runners experiencing it.
Symptoms of ITBS include sharp or burning pain along the outer part of the knee and/or soreness and pain along the outer thigh. Pain can stay localized or radiate up or down. “IT band syndrome is often attributed to ‘tightness’ of the IT band. However, Dungan says the root of the issue is usually poor body mechanics that result in friction or compression of the IT band and underlying tissue where it connects to the knee.
So how does this translate to riding? Dungan says that excessive internal rotation of the hip and knee adduction (when the knee knocks inward) while cycling can cause irritation of the IT band or the fat pad that lies beneath it. This can occur as a result of weak glutes and/or poor neuromuscular control at the hip and/or ankle. She suggests that targeted strengthening and movement retraining with a movement specialist such as a physical therapist can help to correct these mechanics. Unfortunately, foam rolling the IT band, while it may help a little, just doesn’t cut it.
Jason Twedt, professional bike fitting specialist and owner of Bethel Cycle Works in Bethel, Connecticut, agrees. He explains that because the IT band is active throughout the entire pedal stroke, cyclists tend to get IT band issues from friction or the “snapping” of the IT band over the knee joint.
“At the top of the pedal stroke, the IT band is active with the tensor fascia latae,” he says. “When the hip is extended to drive the pedals through the effective part of the pedal stroke, the IT band is active with the gluteus maximus.” In other words, this band is working as hard as you to push the pedals. Like most injuries, ITBS is an overuse syndrome that is usually exacerbated by poor pedaling mechanics and a bad bike fit.
So what can you do if you’re experiencing pain along the IT band before, during, or after a ride? Here are some suggestions from the experts:
Stretch (But Not the IT Band!)
There is a place for stretching in treating ITB tightness—but it’s not stretching the unstretchable. To stretch the muscles of the hip and thigh, try incorporating the following stretches.
Figure 4 Stretch
How to do it: Lie faceup with knees bent and cross left ankle over right knee. Place hands around the backside of right thigh and draw the right knee in toward your chest. Hold for at least 30 seconds. Repeat on other leg. Perform this stretch daily.
Lying Hip Stretch with Strap
To perform the Lying Hip Stretch using a strap, lie faceup with right foot extended up toward ceiling and left leg resting on mat. Loop a yoga strap or belt around your foot and perform a hamstring stretch by gently pulling the leg toward forehead using the strap. Then draw the right leg out to the left side, keeping it straight. Hold in this position for at least 30-seconds. Repeat on left leg.
Strengthen the glutes
According to research performed at Stanford University, strengthening the gluteus medius and maximus is the most important step in avoiding ITB-related pain. As far as strengthening, Fredericson suggests athletes perform the following exercises.
Clamshell
How to do it: Place a resistance band loop around legs just above the knee. Lie on your left side with knees bent, and ankles, knees, and hips stacked. Rest your head on left hand to avoid straining your neck and rest right hand on mat in front of you. Keeping your heels together, rotate right knee up toward ceiling as much as possible. Return to starting position. Complete 15 reps, then repeat on right side.
Side-Lying Leg Lift
How to do it: Lie on left side with legs extended out straight. Prop yourself up on left forearm and rest right hand in front of you on floor. Lift right leg up while keeping your hips steady and facing forward (do not rotate backward). Lower down and repeat. For an added challenge, wear an ankle weight or place a resistance band around ankles. Repeat on other leg.
Glute Bridge
How to do it: Lie faceup on the mat with a resistance band loop around your legs just above the knees and knees bent, heels close to butt, arms at sides. Contract glutes, and press into heels to lift hips up toward ceiling so your body forms a straight line from shoulders to knees as you simultaneously press knees out to keep them in line with hips and maintain tension on the band. Pause. Lower and repeat for 10 to 15 reps.
Hip Hike
How to do it: Stand with left foot on a step, box, or bench at least four inches high with right foot hanging off the edge. Keep both hips squared forward and shoulders level. Place hands on hips for an extra visual aid and balance. Keeping left leg straight, no bend in knee, raise right hip directly upward and then use hip and core to lower right foot below the step. Return to starting position and repeat slowly and with control.
You can also try this glute-strengthening kettlebell workout. Fredericson developed a protocol (known as “The Fredericson Protocol for ITBS,”) to help guide athletes toward the right strengthening regimen.
Adjust Your Bike Fit
Twedt reminds riders that you have three contact points on the bike: your feet, your sit bones, and your hands. Everything in fit starts at the feet. This includes the cleats, soles of the shoes, and foot beds. If any of these are not properly adjusted, it will cause a knock-knee effect up the kinetic chain and contribute to IT band pain. Bike fitting is not a simple process so he suggests seeing a professional to make sure your bike is set up just right for you.
Foam Roll Your Muscles
Though the research on the effectiveness of foam rolling is not conclusive, it sure does feel good to experience that “hurts-so-good” pain. Instead of focusing on the IT band, though, try focusing your foam rolling on the quadriceps, glutes, and hamstrings to help your muscles warm up and cool down before and after rides.
Rest
If you are experiencing pain before, during, or after a ride, along with walking or performing daily activities such as going up stairs or standing, you may need to take a little break. By continuously performing the same repetitive motions that are causing your pain without addressing the actual root of the issue (potentially weak hips or poor bike fit), the only cycle you will be staying on will be one of more pain and inflammation.
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