Many people suffer from lateral knee pain when exercising and competing in sport (1).
The medical explanation of this is often of a short or stiff iliotibial band, and huge amounts of time are invested in isometrics, foam rolling, trigger pointing, massage or needling this structure which seems so resistant to repair.
This article is going to present a few things that you may want to consider in addition to the normal old ITB treatment
Firstly, if we look at the anatomy of the ITB it’s origins begin along the iliac crest as the glute max and TFL merge together and descend from the greater trochanter down to the lateral aspect of the knee (2).
Clearly it can be worth investing time releasing these muscles in addition to an ITB stretch.
Secondly and less known, is how the short head of the biceps femoris (lateral hamstring) affects lateral knee. It attaches over the joint just posterior to the ITB and it’s fascial attachments blend into the ITB. You may wish to test the length, strength and feel of this muscle (3).
Thirdly, the ITB forms part of a strong lateral fascial band that begins in the peroneals of the lower leg, through the ITB before ascends to the lateral obliques, lat dorsi and beyond. Assessing the ROM, strength and quality of these muscles would be beneficial to understanding how each muscle interacts with, and affects other muscles within the fascial band (4).
These fascial bands are illustrated as separate distinct structures in many texts such as Ida Rolf and Anatomy trains, yet in reality these fascial bands are inter-connected like spiders webs to other fascial bands and to other structures not illustrated (4).
When one considers the peroneals and their influence on the lateral fascial line, it might also be worth assessing foot type, foot fall and whether the person propels with a high gear or low gear foot type (5). If they low gear (supinate during propulsion) then this can create greater impact forces through the limb and increase tone along the peroneals and lateral fascial line straight up to the knee and ITB (5).
It can also be common to hear of professionals who release the lateral quad as well as the ITB, after all it can be difficult to know exactly when one ends and the other begins (5).
You may be wondering when I will mention the biomechanics. Whether the person is quad dominant, TFL dominant, how well they run? Do they employ a heel strike, mid foot or fore foot landing? That my friends is a discussion riddled with conflicting and often very poor quality research that flicks between different paradigms that happened to be popular at different time in our professional history. It is also a topic of very detailed clinical reasoning that is too long for this article. But go ahead and squabble as you wish!
1. Maffulli N, Wong J, Almekinders L.C. Types and epidemiology of tendinopathy. Clinics in Sports medicine. 2003. 22(4): 675 – 692.
2. Ober F.R. the role of the iliotibial band and fascia lata as a factor in the causation of low back pain disabilities and sciatica. The journal of Bone and Joint Surgery. 1936 Jan. 18(1): 105 – 110.
3. Marshall J.L, Girgis F.J, Zelko R.R. The biceps femoris tendon and its functional significance. The journal of Bone and Joint Surgery. 1972 October. 54(7): 1444 – 1450.
4. Rolf J.P. Rolfing: Re-establishing the natural alignment and structural integration of the human body for vitality and well-being. Healing Arts Press. October 1. 1979
5. Myers.T.W. Anatomy Trains: Myofascial Meridians for manual and movement therapists. Second edition. Churchill Livingstone, Elsevier. 2009.
David is a Physiotherapist who has been involved in Professional Sport, battlefield trauma, chronic pain and the NHS. He continues to work clinically alongside his development role in Rehab Guru. David is passionate about Health tech to transform outcomes for patients