Knee Pain when running? Is Foam rolling your IT Band really going to help? Or will it just make it worse?

Do you get knee pain when you run? Do you feel it in your IT Band? Been going through the pain of Foam rolling your IT Band but it’s not got better?
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One of the most controversial debates I see across the Therapy/Running world a lot, is whether people should use a foam roller on their IT band (ITB). Now I am not going to tell whether you should or shouldn’t, I’m going to share with you what I have done in the past to help those with similar issues. 

Before we begin let’s just get use to a few things

IT band – The IT band is fascia (not muscle) that run downs the outside of the thigh  
TFL (Tensor Fascia Lata) – A muscle on the outside of the pelvis/thigh which runs continuous into the IT band.
Foam roller –A cylinder object made from foam, used to roll and release apparent tight muscles.

Recently, a runner who is training for the London marathon came to see me. He was experiencing knee pain every time he was running, and it usually occurred after 2-3 miles. It was so uncomfortable he had to stop. He had been foam rolling his ITB for 4 week, without any success, sometimes after foam rolling he felt the knee pain come on quicker!

I wanted to see if I could find any potential causes for this. Firstly I carried out an “Obers Test”, click here to see example video. This test determines the length of the TFL. From here we could see it was showing in a shortened position (Tight). It’s important to note here that TFL can create the tension felt in the ITB, so if TFL is tight it could be making the ITB feel tight (and then we may have the urge to foam roll it!). Now we could simply release TFL, however I felt there was a reason it was short.

We then checked the functionality of the Gluteus medius (Gmed) through a hip abduction firing test, as shown in John Gibbons ‘The Vital Glute’ book. From this test I could see there was a “misfiring sequence” in hip abduction, with TFL “firing” before the Gmed. This could cause the Gmed to appear weak and/or the TFL to overwork causing it to be tight.

So what did we do next?

Well we could simply try to strength Glute med, however if the TFL is  overworking for the Glute med we could run the risk of further overworking the TFL, making the ITB tension even more!
Instead we released TFL through Massage, MET (Muscle energy techniques) and other therapy skills. Once correct hip abduction firing patterns were restored, we then incorporated some Glute med strengthening exercises. Its key to point here, carrying out homework exercises was essential. We need to re-address that pattern consistently and had the homework exercises not been carried out (3 times per day) it is likely things would have stayed the same and progress would have been very limited (if at all).

After few sessions working on this (along with some other biomechanical dysfunctions we found in our first sessions) and completion of homework exercises to the required amount, my client has got his training programme back on track and is preparing.

If you have any questions at all or need any help, please feel free to ask.

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Alex
Reference
Gibbons, J. 2014. The Vital Glutes p83.

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