Hi All!
I’m joining this one late, again… and once again, this will likely be
lengthy…
IT Band trouble is rarely a primary cause of knee pain, or an
independently occurring malady. Unfortunately, there are no very good
studies of IT band syndrome. For instance, some researchers have found
that running across inclines causes IT band symptoms to occur in the
uphill leg, while others have found that the symptoms occur in the
downhill leg. Some researchers have found that slow running relieves
IT band symptoms in runners while others have found that faster
running relieves the symptoms… what the studies do not control for is
proximal (hip) and/or distal (lower leg) variables. Instead, most
researchers have only looked at “IT band tightness”, though some have
looked at the relationship between IT band symptoms and lower leg
external rotation (in ballet dancers). The upshot is that there is no
good research which implicates the IT band as a primary or independent
problem.
It is also important to note that the iliotibial band cannot be
stretched—you can apply tension through it, but there is no evidence
that a plastic change in its length can be made. We can stretch the
muscle (the tensor fascia latae) to which the IT band blends at the
pelvis, but even that will not produce an IT band length change. The
muscle itself (which, incidentally is only approximately 3-4" long),
when stretched will have minimal, if any effect on IT band syndrome.
The IT band becomes symptomatic when it is exposed to excessive
friction as the lateral femoral epicondyle moves under the IT band
during knee flexion and extension. There is a bursa—a cushion of sorts—
between the epicondyle and the IT band to minimize this friction.
When considering IT band problems, it is important to think about the
effect of the proximal attachment at the anterolateral aspect of the
pelvis and the distal attachment at Gerdy’s tubercle on the
anterolateral tibia a few centimeters distal to the jointline of the
knee. Proximally there is very little motion relative to the
underlying structures while distally there is greater motion relative
to underlying structures. When the orientation of the lateral
condyles of the tibia change relative to the epicondyles of the femur,
the IT band may be exposed to greater friction forces and becomes
susceptible to irritation, with pain following.
The orientation of the condyles and epicondyles can be most adversely
affected by either external rotation (“toes out”) of the lower leg
without rotation of the femur or internal rotation of the femur
(“knock-knees”) without rotation of the lower leg (that is, the lower
leg remaing neutral with toes pointing straight ahead). The worst-case
scenario is a combination of the two conditions. In either case
(femoral internal rotation or tibial external rotation), the
epicondyle of the femur is made more functionally prominent and
abrades the underside of the IT band.
There are several ways the orientation of the condyles/epicondyles may
occur. To create tibial external rotation: excessively tight lateral
hamstrings (biceps femoris) or excessively tight calf muscles
(gastrocnemius) lateral head, excessively weak medial hamstrings
(semitendinosis and semimembranosis) or medial gastrocnemius,
articular surface defects (such as arthritis) which my alter the path
of the tibia on the femur during knee extension/flexion. To create
femoral internal rotation: weak hip abductors and/or external
rotators, excessively tight hip adductors (inside thigh muscles) or
hip internal rotators. Of course, in cycling, poorly positioned cleats
can also create this problem.
How to "fix" IT band syndrome? Well, first tease out the cause
(weakness vs. tightness vs. a combination of the two). Then perform
the relevant exercises ("clamshells" with elastic resistance bands
around the knees and/or lateral stepping with elastic resistance bands
around the ankles for strengthening and hamstrings, adductors, calf
stretches for flexibility), ice and/or anti-inflammatories to control
swelling and pain. In extreme cases, some manual therapy in the form
of soft-tissue mobilization to reduce scar tissue may be required.
Regarding Patrick in VT's (I hear you folks got a good dump of snow
recently :) ) understanding that the effect of heavy resistance
creating excessive contact pressure between the articular surfaces of
the knee cap and the trochlear groove in which the knee cap glides,
there is, again, no evidence to support this as being damaging to the
knees. The exception to this is if one spends a substantial amount of
time kneeling on a hard surface (tile setters, for instance experience
this commonly). Prolonged heavy direct pressure can cause deformation
of the articular cartilage of the knee cap which may lead to
biomechanical pathology or simply pain. In exercises--even very heavy
squatting--there is little risk of damage to the cartilage of the knee
cap, presuming the rest of the kinetic chain is strong enough to
withstand the heavy exercise. In fact, compressive loading of
cartilage is actually essential to the health of the articular
surface. So…
Patrick Moore, unless you've already a knee problem, there's little
danger in unseated climbing on the fixed gear (and I'm happy that this
is so as I spend a great deal of time in that climbing mode, myself!)…
enjoy :)
I hope this helps!
lyle f bogart dpt
tacoma, wa
On Jan 5, 2:07 pm, Patrick in VT <[email protected]> wrote:
> On Jan 5, 2:47 pm, PATRICK MOORE <[email protected]> wrote:
>
> > Thanks, Patrick; I do appreciate your reply.
>
> well, I hope some one can give you a more definitive answer. and i
> certainly don't want to be discouraging - I also ride fixed gear, and
> often push a bigger gear than I probably should. but knees ain't as
> easy to replace cartridge bearings, you know? so i try to be careful
> and moderate. anyway, if you don't mind, I'll continue to
> speculate . ... .
>
> >I should have been more clear about what I meant by "stair stepping:" I have
> >in >mind those machines that people use in gyms
>
> i don't think this is a comparable exercise. a normal step, even on
> one of those machines, would probably be around 6-8 inches. when
> pedaling, you're forcefully extending your leg and putting your knee
> under load for roughly double that range of motion. in any event,
> this video may help to visualize things -
>
> http://www.youtube.com/user/Linearc
>
> > although sitting and shoving a pedal over in too high a gear is by all
> > accounts, >and by my own experience, bad for your knees, is standing to
> > push over a >similar gear necessarily a bad thing in the long run?
>
> i guess that's my point: whether sitting or standing, you're putting
> an excessive load on your knees when geared to high. and it's the
> load that matters when it comes wear and tear on joints.
>
> no time for research, but google spit these sheldon articles out
> quickly
>
> http://www.sheldonbrown.com/standing.htmlhttp://www.sheldonbrown.com/fixed-knees.html
--
You received this message because you are subscribed to the Google Groups "RBW
Owners Bunch" group.
To post to this group, send email to [email protected].
To unsubscribe from this group, send email to
[email protected].
For more options, visit this group at
http://groups.google.com/group/rbw-owners-bunch?hl=en.
