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Do you have Upper Iliotibial Band Pain?

What are the Symptoms of Upper Iliotibial Band Pain Syndrome?

This can be a confusing answer because this enormous band of connective tissue crosses two joints, the hip and the knee. The primary symptom is LATERAL thigh and hip pain. This usually includes hip or buttocks pain and sometimes low back pain on the same or opposite side. The lateral thigh pain can include discomfort down to the lateral knee and even the ankle. A very tight feeling is often present at the site of pain and in that groin. The symptoms are generally relieved by walking and motion. If there is additionally a sacroiliac joint strain, which is common for ITB pain, sitting is irritating. Otherwise, sitting quickly relieves the pain. Lying on the side of pain always aggravates it. Lying on the opposite side or on the back normally relieves it. Standing still for an extended period, as in waiting in line, increases the discomfort.

What is the Iliotibial Band (ITB)?

The ITB is a broad band of tough, elastic tissue that runs along the side of the hip down to just below the side of the knee. Another name for the iliotibial band is the iliotibial tract. Like any tract, it is comprised of many individual fibers acting in unison. In this case, the fibers are connective tissue. The tract runs from the pelvic crest on each side to just below the outside of the knee. Stand with your hands on your hips. Now slide your hands down the sides of your thighs to just below the outside part of your knees. You have just, roughly, outlined the size and shape of the ITB. Its' fibers are intimate with the tensor fascia lata (TFL) muscle, which attaches to the top of the pelvis. Because of this the ITB can shorten and lengthen under different conditions. When the TFL/ITB shortens, or contracts, it causes the thigh and leg to go outward and forward, and that foot to turn inward. The TFL/ITB can also cause the knee to bend or straighten depending on the angle at which the knee is situated when the contraction occurs.

Why does ITB Syndrome Cause These Presistent Problems?

This question can be answered in two words: PELVIC ASYMMETRY. Hold your hands up with the palms facing away from you. Now put them together so that the thumbs bump each other. This resembles the pelvis with its' right and left halves. Starting from this (symmetric) position take your right hand and tilt it so that those fingers are more forward than on the left. This represents what happens to the pelvis when it rotates forward on the side of ITB pain. Now, in that same hand position tilt your right hand in a different plane so that the little finger side of that hand is more forward. This represents the additional deviation that occurs in this right ITB syndrome. Now, in this hand position tip the two hands so that the right one is higher than the left. Now this rather severe pelvic asymmetry and right ITB problem are complete. You can see from this analogy why it is not so easy to explain this condition in very simple terms. The band only works normally when it is operating in its' correct and shortest line of force, so that the tension on it is minimal at rest. This occurs when the two halves of the pelvis are symmetric.

Excuse the over-simplification, but think of the band as if it were a guitar string. Like the ITB, the string also crosses two points, the tuner bridge at the top and the fixed bridge at the bottom. When the guitar string is in tune, at its' perfect length, it twangs correctly and all is well. Over time the string becomes less adjusted. Either it stretches and becomes looser or the crazy guitar player bends the string sideways and it becomes tighter. Since it is so broad, the ITB is more like all six of the strings acting in unison. The effect of incorrect length accumulates in all six strings of the guitar over time and the thing sounds lousy. Likewise, the length change of the countless fibers of the ITB occurs gradually over time until one day symptoms begin.

Like the guitar string that is over-adjusted, the ITB is over-tightened when the pelvic crest (the bone you touch when you place your hands on your hips) cocks forward. Like the guitar string that becomes too loose, the ITB becomes flaccid (loose) when that side of the pelvis drops lower, as in some sacroiliac sprains, and the opposite side of the pelvis elevates. This explains why some cases of ITB pain occur on the side opposite the sacroiliac strain. Also, these asymmetric pelvis deviations cause various pelvic stabilizing muscles to tighten in an attempt to right the ship. For example, hip adductors get taut on one side causing an ache in the groin area at times. This effect can occur on either the same side or opposite side as the leg symptoms.

ITB Self-Test:

Check yourself for possible pelvic asymmetry and, therefore, potential for ITB pain and dysfunction-

1. Sit with legs in figure four position with knees outward and feet together. Does one knee stay more upright while the other drops lower? Is there a difference in how tight each side feels?
2. When standing still for long do you always tend to shift your weight onto the same leg for comfort?
3. When you bend your trunk sideways is one side tighter than the other?
4. When you touch your toes is one hamstring tighter?
5. Does one pelvic/buttock side feel good when hard pressure, like your fist, is pushed against it from behind?

The Other Side of Pelvic Asymmetry:

This article has been dedicated to the muscular aspects of dysfunction related to pelvic asymmetry. The other side of this coin is the ligament aspect associated with pelvic asymmetry, mainly SACROILIAC (SI) SPRAIN- but that is a topic for another article. You can find one by Clinking this link.

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