Yoga and Meditation

Are you taking your training seriously? Then it is very probable that you have had or have problems with your knees. The most common knee injury is the Iliotibial band syndrome. Sometimes this is also called Iliotibial band friction syndrome. People suffering from IT band syndrome typically feel a diffuse pain in the knee. Sometimes they also feel a painful, sharp localized discomfort nearby the knee joint.

The Iliotibial band is a tough band of tissue running along the thigh bone. It starts at the hip and ends on the shinbone, shortly beneath the knee joint. Until recently it was believed that by flexing and extending the leg, the IT band was rubbing against the thigh bone, nearby the knee joint. This rubbing would cause friction and the friction would make the Iliotibial band sore. This soreness would be the cause of the pain.

Fairclough et al. has found out that the IT band is not rubbing at all. The pain in the knee is caused by a pressure from the IT band on a fatty tissue, placed between the Iliotibial band and the knee joint. The tissue consists of nerves, which when stressed will give you a feeling of pain. The pressure on the tissue is build up through flexing and extending the leg.

This new understanding of the Iliotibial band syndrome makes it clear that to reduce the pain, you have to reduce the tension (pressure) on the IT band. This can only be done through reducing the tension in the muscles connecting to it. The connecting muscles are the gluteus maximus and the tensor fasciae latae which is a muscle of the thigh.

Strengthening and stretching are important counter measures to the tension in the Iliotibial band. I recommend taking a look at different Yoga postures for finding suitable stretching exercises.

Typical symptoms of Iliotibial band syndrome are:

* Pain just above the knee joint

* Swelling or thickening of the Iliotibial band over the lateral femoral epicondyle

* Pain at the hip

* Diffuse pain in knee area

* Sharp pain at the lateral femoral epicondyle

* Clicking - it feels as if the IT band tightens and snaps across the joint

Typical causes for IT band syndrome are:

* Increasing distance too quickly

* Running downhill

* Cycling with the feet in an excessive angle

* Running on a crowned surface

* Uneven leg length

* Bowlegs

* The hip abductor muscles are too weak

Typical treatment of ITBS are (non-surgical):

* Putting ice on the sore spot

* Stretching

* Massage

* Rest

* Hip abductor strengthening

For those of you who havent got a problem with the IT band, the following methods could help preventing it:

* Stretching (Hamstrings, gluteal muscles and quadriceps)

* Strengthening of hamstrings, quadriceps, calf muscles and hip abductors

* Gradually increasing training volume

* No downhill running

* Rest

* Shorten your stride

* Using a correct sit position on the bike

References:

Cosca DD, et al.; Common problems in endurance athletes; Am Fam Physician. 2007 Jul 15;76(2):237-44

Devan MR, et al.; A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities; J Athl Train. 2004 Jul-Sep; 39(3): 263-267

Ellis R, et al.; Iliotibial band friction syndrome ” a systematic review; Man Ther. 2007 Aug;12(3):200-8

Fairclough J, et al.;Is iliotibial band syndrome really a friction syndrome?; J Sci Med Sport. 2007 Apr;10(2):74-6

Fairclough J, et al.; The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome; J Anat. 2006 Mar;208(3):309-16

Farrell KC, et al.; Force and repetition in cycling: possible implications for iliotibial band friction syndrome; Knee. 2003 Mar;10(1):103-9

Fredericson M, et al.;Practical management of iliotibial band friction syndrome in runners; Clin J Sport Med. 2006 May;16(3):261-8

Fredricson M, et al.; Iliotibial band syndrome in runners: innovations in treatment; Sports Med. 2005;35(5):451-9

Grau S, et al.; Hip abductor weakness is not the cause for iliotibial band syndrome; Int J Sports Med. 2008 Jul;29(7):579-83

Hamill J, et al.; A prospective study of iliotibial band strain in runners; Clin Biomech (Bristol, Avon). 2008 Oct;23(8):1018-25

Khaund R, et al.; Iliotibial band syndrome: a common source of knee pain; Am Fam Physician. 2005 Apr 15;71(8):1545-50

Miller RH, et al.; Lower extremity mechanics of iliotibial band syndrome during an exhaustive run; Gait Posture. 2007 Sep;26(3):407-13

Paluska SA; An overview of hip injuries in running; Sports Med. 2005;35(11):991-1014

Tibor LM, et al.; Differential diagnosis of pain around the hip joint; Arthroscopy. 2008 Dec;24(12):1407-21

Wanich T, et al.; Cycling injuries of the lower extremity; J Am Acad Orthop Surg. 2007 Dec;15(12):748-56