Is IT Band Tendinitis Really a Tendinitis?
Research has clearly shown that the IT band itself is probably not the anatomy that gets inflamed … which has significant implications for treatment
This short article introduces you to a basic concept in IT band pain that surprises almost everyone, including doctors and all-too-many physical therapists.
Iliotibial band syndrome is a mysterious condition. It’s amazing how many things we still don’t understand about it. You would think that science would have mastered a little thing like this long ago! But that’s not the case — sports medicine is still surprisingly basic.
For instance, it was only recently discovered that the IT band does not actually “rub” across the side of the knee, as the conventional wisdom had always assumed (it even used to be called IT band friction syndrome for this reason).
In 2007, John Fairclough of University of Wales Institute, with seven coauthors, challenged the definition of iliotibial band syndrome, and even of the iliotibial band itself, in a paper published in the Journal of Science and Medicine in Sport. They presented a compelling analysis, concluding that “the perception of movement of the ITB across the epicondyle is an illusion.”
They were basically suggesting that the function and anatomy of the iliotibial band has been misunderstood and oversimplified for decades!
And then again in 2008 this new idea was strongly validated by a new study. Michels et al operated on 35 knees, trying to solve IT band syndrome in a completely new way, based on the new understanding of the anatomy. If the new theory was wrong, their procedure would be pointless and ineffective. But it worked!
So what’s actually inflamed?
If the iliotibial band is not the irritated structure in ITBS … what is?
The most likely suspect is actually a layer of fat and loose connective tissue pinched between the iliotibial band and the knee! And this isn’t just an educated guess: it is supported by MRI studies, which provide good evidence that it is a layer of tissue under the iliotibial band that is inflamed (an abnormal appearance in the scan compared to healthy knees). Dissection study has also shown evidence of this. And of course there is also the brand new study by Michels et al mentioned above.
So it’s not so much a “tendinitis” as a “layer-of-fat-itis.”
Other problems with the conventional wisdom
Oy, where do I start?!
If IT band syndrome isn’t really a tendinitis, exactly, then most of the conventional wisdom already has to go out the window right there. But there are numerous other problems and surprises, like the fact that researchers have also found that people with iliotibial band syndrome don’t have tight IT bands! Or at least, no more than anyone else.
Hip strengthening, often optimistically believed to be a cure for this condition, is under heavy scientific attack the past couple years.
An array of structural problems such as short legs and tilted pelvises, once assumed to be the root cause of the problem, are looking less and less likely to have anything to do with runner’s knee.
So, what should you do?
You cannot actually expect to get good advice from most doctors and therapists about ITBS. Your knee pain is an important problem to you, but to most professionals it’s just a trivial entry in a textbook — probably an old textbook, that doesn’t come within ten years of including this new information. As a student of massage therapy in the late 90s (a 3-year program that was much more academic than most massage therapy training), I probably studied no more than a paragraph about ITBS, and perhaps I answered a single test question about the condition in my entire education. This would be typical in physical therapy. Very few professionals have a firm grip on recent IT band science.
Fortunately, most people with IT band “tendinitis” recover reasonably well with a little rest and ice. However, many cases do become chronic, especially if some unwise trainer or therapist advises you to try to exercise your way out of it (bad idea, by the way). If you’re serious about your knees, it’s well worth it to learn all about iliotibial band syndrome … and learn it sooner rather than later.
An extremely detailed iliotibial band syndrome tutorial
I make my living by studying pain problems like iliotibial band syndrome for years, and then publishing and selling best-in-class tutorials about them. I have published 0 of them over the last 24 years. My goal is to make each one of them the single best resource on the subject. My ITBS tutorial has always been one of the most popular, always in the top three. So many people have the condition, and so many people have gotten frustrated by ineffective treatment, that the tutorial seems to have found an large audience. For many years now it has been the best thing you can find on the subject … and it is still constantly improved by reader feedback and by integrating new scientific evidence.
Paying in your own (non-USD) currency is always cheaper! My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion.
Example: as a Canadian, if I pay $19.95 USD, my credit card converts it at a high rate and charges me $26.58 CAD. But if I select Canadian dollars here, I pay only $24.95 CAD.
Why so different? If you pay in United States dollars (USD), your credit card will convert the USD price to your card’s native currency, but the card companies often charge too much for conversion — it’s a way for them to make a little extra money, of course. So I offer my customers prices converted at slightly better than the current rate.
refund at any time, in a week or a year
call 778-968-0930 for purchase help
| company | PainScience.com |
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| owner | Paul Ingraham |
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Save a bundle on a bundle
The e-boxed set is a bundle of all 10 book-length tutorials for sale on PainScience.com: 10 books about 10 different common injuries and pain problems. All ten topics are (all links open free intros in a new tab/window): muscle strain, muscle pain, back and neck pain, two kinds of runner’s knee (IT band syndrome and patellofemoral pain), shin splints, plantar fasciitis, and frozen shoulder. (Headache coming soon, fall of 2019.)
Most patients only need one book, because most patients have only one problem. But the set is ideal for professionals, and some keen patients do want all of them, for the education, and for lending to friends and family. And, of course, you do get a substantial discount for the bulk purchase. But no rush—complete the set later, minus the price of any books already bought. More information and purchase options.
Keep reading for free! The book page has a substantial free introduction, and there other free samples from the book and closely related articles:
- EXCERPT IT Band Stretching Does Not Work
- EXCERPT Does the IT Band Move After All?
- EXCERPT The Causes of Runner's Knee Are Rarely Obvious
- EXCERPT Do IT Band Straps Work for Runner’s Knee?
- IT Band Pain is Knee Pain, Not Hip Pain — Pain in the hip and thigh is something else, I promise
- Diagnosing Runner’s Knee — It usually starts with lateral knee pain during and after runs, but there are two major types
- Is Running on Pavement Risky? — Hard-surface running might be a risk factor for running injuries like patellofemoral pain, IT band syndrome, shin splints, and plantar fasciitis
Paying in your own (non-USD) currency is always cheaper! My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion.
Example: as a Canadian, if I pay $19.95 USD, my credit card converts it at a high rate and charges me $26.58 CAD. But if I select Canadian dollars here, I pay only $24.95 CAD.
Why so different? If you pay in United States dollars (USD), your credit card will convert the USD price to your card’s native currency, but the card companies often charge too much for conversion — it’s a way for them to make a little extra money, of course. So I offer my customers prices converted at slightly better than the current rate.
refund at any time, in a week or a year
call 778-968-0930 for purchase help
If you choose to buy, thanks in advance for your business, and please feel free to write to me about something unusual or interesting about your case. I routinely make improvements to the tutorial as a result of feedback from runners and readers and health care professionals around the world.
