Are you having knee problems? Knee pain is one of the most common injuries in runners and cyclists. The IT syndrome or Iliotibial band friction syndrome as it is also called, is the most common knee problem. IT-Band syndrome causes a diffuse pain in the knee and sometimes also a painful, sharp localized discomfort nearby the knee joint.

The tough tissue band running along the knee bone, from the hip to the shinbone, called IT band was until recently rubbing against the thigh bone, nearby the knee joint, according to researchers. Flexing and extending the leg would cause this rubbing phenomena and that would cause friction. The friction would make the Iliotibial band sore and this soreness was the cause of the pain.

Today the researcher know, that the IT band is not rubbing at all (Fairclough et al.). The cause for the pain is pressure from the Iliotibial band on a fatty tissue, placed between the Iliotibial band and the knee joint. This tissue consists of a lot of nerves, which when stressed will give a feeling of pain. Flexuring and extending the leg build up the pressure on the fatty tissue.

With this new understanding of the biomechanics of the Iliotibial band syndrome it has become clear that to reduce the tension on the Iliotibial band you have to reduce the tension in the muscles connecting to it. That is primarily the gluteus maximus, the biggest muscle of the buttocks, and the tensor fasciae latae which is a muscle of the thigh.

You can reduce the tension through stretching and strengthening them. The stretching exercises I proposed in my last post 8 Yoga poses for removing or preventing knee pain (IT band) could help you with that.

Typical symptoms of Iliotibial band syndrome are:

* Pain just above the knee joint

* Swelling or thickening of the IT band over the lateral femoral epicondyle

* Pain at the hip

* Diffuse pain in knee area

* Sharp localized pain at the lateral femoral epicondyle

* Clicking - as if the IT band tightens and snaps across the joint

Typical causes for Iliotibial band syndrome are:

* Increasing distance in training too fast

* Running downhill

* Cycling with the feet in an excessive angle

* Running on a crowned surface

* Uneven leg length

* Bowlegs

* Weak hip abductor muscles

Typical treatment of Iliotibial band syndrome are:

* Putting ice on the sore spot

* Stretching

* Massage

* Rest

* Hip abductor strengthening

For those of you who havent got a problem with the IT band, the following methods could help preventing it:

* Stretching

* Strengthening of hamstrings, quadriceps, calf muscles and hip abductors

* Slowly increasing training volume

* No downhill running

* Rest

* Shorten your stride

* Using a correct sit position on the bike

References:

Cosca DD, et al.; Common problems in endurance athletes; Am Fam Physician. 2007 Jul 15;76(2):237-44

Devan MR, et al.; A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities; J Athl Train. 2004 Jul-Sep; 39(3): 263-267

Ellis R, et al.; Iliotibial band friction syndrome ” a systematic review; Man Ther. 2007 Aug;12(3):200-8

Fairclough J, et al.;Is iliotibial band syndrome really a friction syndrome?; J Sci Med Sport. 2007 Apr;10(2):74-6

Fairclough J, et al.; The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome; J Anat. 2006 Mar;208(3):309-16

Farrell KC, et al.; Force and repetition in cycling: possible implications for iliotibial band friction syndrome; Knee. 2003 Mar;10(1):103-9

Fredericson M, et al.;Practical management of iliotibial band friction syndrome in runners; Clin J Sport Med. 2006 May;16(3):261-8

Fredricson M, et al.; Iliotibial band syndrome in runners: innovations in treatment; Sports Med. 2005;35(5):451-9

Grau S, et al.; Hip abductor weakness is not the cause for iliotibial band syndrome; Int J Sports Med. 2008 Jul;29(7):579-83

Hamill J, et al.; A prospective study of iliotibial band strain in runners; Clin Biomech (Bristol, Avon). 2008 Oct;23(8):1018-25

Khaund R, et al.; Iliotibial band syndrome: a common source of knee pain; Am Fam Physician. 2005 Apr 15;71(8):1545-50

Miller RH, et al.; Lower extremity mechanics of iliotibial band syndrome during an exhaustive run; Gait Posture. 2007 Sep;26(3):407-13

Paluska SA; An overview of hip injuries in running; Sports Med. 2005;35(11):991-1014

Tibor LM, et al.; Differential diagnosis of pain around the hip joint; Arthroscopy. 2008 Dec;24(12):1407-21

Wanich T, et al.; Cycling injuries of the lower extremity; J Am Acad Orthop Surg. 2007 Dec;15(12):748-56

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This article shows you 7 yoga asanas that efficiently help triathletes, cyclists and runners with stiff muscles.

Runners and cyclist often suffers from stiff legs. This can cause problems as Iliotibial band syndrome and back problems.

If you haven’t got any yoga experience or if you just got started with yoga, these asanas are a great start for getting more flexible leg muscles. I have chosen to write the english name as well as the sanskrit name to make it easier for you to find videos or pictures of the postures on the web. I recommend looking at youtube for instructions on how to do the bends.

When your legs are more flexible, they can perform with less resistance. It will be possible to run or cycle more efficient. It will also help you to avoid overuse injuries as iliotibial band syndrome. I have noticed that when I started doing yoga or stretching, I didn’t get any knee pain anymore.

It is normal for beginners to feel a light sensation of pain when trying to get into the different poses. Don’t give up! Through regular stretching you will gain flexibility and it will be much easier getting into the postures. In the end you will really enjoy them.

The postures (asanas) that I suggest for the beginning are the following seven:

Standing forward bend (Uttanasana): A pose for increasing the flexibility in your hamstrings, spinal muscles and the gluteus maximus, medius and minimus. If you suffer from a back injury, you should take it easy with this bend. It is important letting gravity do the work. No pushing your body into this posture. If you have tight hamstrings, bend your knees to improve the stretch.

Warrior I (Virabhadrasana I): In runners and cyclists, the hip flexors is a normal weak point. The Warrior I works on those flexors. The Warrior I will increase your flexibility in the hips, back and front groins.

Warrior II (Virabhadrasana II): This is another pose that will stretch your hip joints. It will also open the groins and stretch the inner thigh muscles.

Side Angle Pose (Parsvakonasana): This is a good following pose of Warrior II. It stretches the back side of the legs and opens the groin. At the same time it also stretches the upper body.

Triangle Pose (Trikonasana): This is a follow up of the Warrior I pose. Works the side body and the hips.

Intense side stretch (Parsvottanasana): This is another very good stretch for your hamstrings and it will also increase the flexibility in your gluteus maximus. This posture is more intense in the hamstrings than the standing forward bend.

Wide stance forward bend (Prasarita Padottanasana): For stretching your hamstrings and gluteus maximus, this is a very good pose. The difference to the standing forward bend is that in this posture you have your feet wider apart. It is also called wide-legged forward fold.

To get the most of the poses described above, stay for five deep breaths in position. By doing the asanas regularly you will open up your groin and increase the flexibility in your legs and hips. This will reduce the risk of getting problems with overuse injuries. I recommend doing these asanas at least three times a week and when you have done them for 2 months we can go to the next level.

I hope these Yoga asanas will help you enjoying your sport!

Gunnar

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