Soft knee straps with velcro closures are often recommended for iliotibial band syndrome, a painful and common knee injury. Knee straps are intended to be worn just above the knee.1 But while it is clear that straps may have some therapeutic benefit, they are almost certainly not your best option for self-treatment of iliotibial band syndrome. In fact, they are near the bottom of the list!
On the bright side, they are also cheap and risk-free.
Read on to find out how straps are supposed to work, how well they work, and exactly what to buy and what to try.
Reader Karen McCullough wrote in to ask:
After reading your article, I thought the strap idea was probably crap. But another health care professional just told me that she’d done some research, and that the idea behind the strap was to loosen the iliotibial band on the pad of fat tissue by tightening the ITBS right above it. What do you think?
Karen McCullough, Whitewater, Wisconson
I’m such a debunker that I usually don’t have much nice to say about products like this. I’m also very skeptical about blaming pain on biomechanics.2 But in fact I actually think straps do have some potential to help — just not for the reason given by Karen’s source (and practically everyone else). There are many such “mechanical” explanations of why straps work.
Clearly there is some confusion about just what, exactly, this product is supposed to do for your knees. Even the people who sell them can’t get their story straight. But whatever the mechanism of action might be, it is almost certainly not mechanical. The idea Karen heard was wrong in at least two ways:
Nevertheless, there is decent (albeit indirect) evidence that the strap can help! Joint function depends on extremely complex sensory input and motor output relationships. Exactly how we use our knee depends heavily on how our knee feels. The “feeling” of knee use is based on the “6th sense” of proprioception (see Proprioception, the True Sixth Sense), and involves an enormous amount of neurological data.
Wearing the strap alters proprioception in the knee and that often has a (slightly mysterious) benefit for various types of knee pain, including iliotibial band syndrome. This has been suggested by experimental results — it’s not that far out.3And there’s another plausible neurological mechanism for relief: In chronic cases, pain may be caused as much by central sensitization4 as by any on-going problem with the tissue. There’s even interesting evidence that the stubbornness of the pain is a trait of the individual, rather than due to the state of the knee.5 The novel sensory input of the strap may force the nervous system to “reconsider” how the knee should feel. Exactly how we use our knee depends heavily on how our knee feels.
Anecdotally, I have certainly seen some signs that the strap is helpful, although your mileage will definitely vary. Some people get absolutely no results from it, while others seem quite strongly affected. But remember, this is a cheap and easy and risk-free intervention … which means that if there is the slightest evidence that it works, it is firmly in the “worth a shot” category of treatments! There is really no reason not to try it.
I recommend that you drop in on FootSmart.com and pick their Pro-Tec Iliotibial Band strap for just $15 (USD). “One size fits most,” and they have a 120-day satisfaction guarantee, so you can return it if it doesn’t do the trick for you.
Practically anyone shopping for knee straps would be better off learning more about iliotibial band syndrome first. But what to read? Who to ask? As usual for any topic, Googling for “iliotibial band syndrome” gets you an almost unbelievable number of results. Most are short, poorly written, and inaccurate.
Thanks to the misinformation explosion, myths and misconceptions about iliotibial band syndrome are even more widespread than they used to be, even among health care professionals.
Some health care professionals have taken the time to study ITB syndrome properly, of course. But it’s usually hard find one of them before your training schedule is blown to smithereens.
I have taken years of research and professional experience and put it all into a detailed, referenced article which will teach you basically everything there is to know about ITB syndrome. The information about straps offered above is excerpted from just one of sections in the article: thorough reviews of every plausible treatment options (and some implausible ones).
I do not offer a foolproof system for beating iliotibial band syndrome, because there is no such thing. But I know that you will understand this frustrating condition better than most health care professionals by the time you are done. It’s just like coming to my office and having a nice long conversation about it, where all your questions get answered.
Full access to the ITBS tutorial is available immediately for USD$1995. Click the “Buy Now” button to purchase access.
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— Miscellaneous minor improvements, repairs, and modernization. It had been at least 7 years since this article got some attention! Yoinks. 😮 Added brief discussion of the role of central sensitization.
This article provides an important clue that may help to rationalize the use of a “Patt Strap,” “Cho Strap” or “iliotibial band syndrome strap,” and also suggests a possible mechanism for therapeutic effect on patellofemoral syndrome in particular, as well as other problems. This evidence suggests that proprioception is enhanced by patellar taping. From the abstract: “Subjects with good proprioception did not benefit from patellar taping. However, in those healthy subjects with poor proprioceptive ability ... patellar taping provided proprioceptive enhancement.” Ten years later, the same researchers demonstrated that brain activity is modulated by taping (see Callaghan 2012).BACK TO TEXT
In more than 2000 people with knee osteoarthritis, or at high risk for it, pain sensitization was associated with knee pain, but not the severity of the arthritis as seen on x-ray. In other words, neither pain nor sensitivity clearly correlated with the condition of their knee. This contradicted the researchers’ expectation that sensitization is caused by the duration and severity of arthritis. Instead, the results suggest that “sensitisation is in fact a ‘trait’ rather than a ‘state’, that is, that hypersensitivity was present before knee OA, related to an individual’s predisposition to sensitisation rather than being induced by peripheral nociceptive input [pain] from osteoarthritis.” Even more simply stated: people with knee pain have a problem with pain, not knees.BACK TO TEXT