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Is IT Band Tendinitis Really a Tendinitis?

Recent research has clearly shown that the IT band itself is not the anatomy that gets inflamed, which has significant implications for treatment

Paul Ingraham, updated

This short article introduces you to a basic concept in IT band pain that surprises almost everyone, including doctors and physical therapists.

Iliotibial band syndrome is a mysterious condition. It’s amazing how many things we still don’t understand about. You would think that science would have mastered a little thing like this long ago! But that’s not the case.

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 a 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. In school, I probably studied no more than a paragraph about ITBS, and perhaps I answered a single test question about the condition in three years of training. I would estimate that less than 1% of 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

In addition to hands-on therapy, I make my living by studying pain problems like iliotibial band syndrome for years, and then publishing and selling extremely best-in-class tutorials about them. I have published eight such tutorials since 1999. I set out to make each one of them the single best resource on the subject. My ITBS tutorial has always been the most popular of them — so many people have the condition, and so many people have gotten frustrated by ineffective treatment, that the tutorial seems to have found an extremely large (and grateful) audience. For many years now my tutorial 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. There’s simply nothing else like it.

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BUY NOW $1995 USD
Logos for Visa, Mastercard, and Amex.I accept Visa, Mastercard, and American Express. Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. Note that my small business does not handle your credit card info: it goes straight to the payment processor (Stripe). You can also pay with PayPal: for more information, click the PayPal button just below.
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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.