Causes Of Iliotibial Band / ITB Pain

All the symptoms that our bodies generate have multiple possible causes, it’s a big part of what makes healthcare such a big challenge –  and it’s definitely the case with Iliotibial Band / ITB pain. If you’ve had Iliotibial Band / ITB pain for some time it can become pretty frustrating trying to get to the underlying cause of your pain. Many find that despite seeing multiple practitioners answers and solutions are not forthcoming. If you are seeking to understand the possible causes of your Iliotibial Band / ITB pain you’ve come to the right place!

IT Band Syndrome Caused By Movement Issues

The Iliotibial Band / ITB is a key mechanical structure within the body.  Specifically, it helps create mechanical synergy between the knee, hip, and ankle. The mechanical nature of the Iliotibial Band / ITB  inevitably means the vast majority of the ITB issues we suffer are mechanical in nature. ‘Mechanical’ pain is pain caused by a movement or postures that the body doesn’t like.

Many mechanical problems are subtle and take a long time to build up to full blown Iliotibial Band / ITB pain. If for example you are born with flat feet, chances are you won’t have any Iliotibial Band / ITB pain during your childhood. As you get older though that may change. 

As you start to wear corporate footwear every day and become more sedentary you might find that the flat-footedness starts to catch up with you in the form of Iliotibial Band / ITB pain. This is because the arch collapsing creates increased strain in the hip and Iliotibial Band / ITB pain with each step – over time.  Bearing in mind we take millions of steps a year. 

The more the years go by, and the less ideal your footwear and lifestyle become the more likely your flat feet are to show up as Iliotibial Band / ITB pain. This is just one of many possible ways that a mechanical issue can turn into Iliotibial Band / ITB pain.

One of the surprising things about Iliotibial Band / ITB pain is that it can show up more like a sudden injury to the hip or knee region. Sudden Iliotibial Band / ITB pain / ‘injuries’ feel fine one minute and hurt the next. But they are often complex and have built up over time.

Mechanical issues that may contribute to hip pain include…

Flat Feet

High Arches

Weak Quads

Weak Glutes 

Wide Pelvis 

Tight Hamstrings 

Old Injuries

IT Band Syndrome Caused By Injuries

It is very very hard to injure a healthy Iliotibial Band. Nonetheless, there are numerous injury type mechanisms that can lead directly to Iliotibial Band / ITB pain. The  Iliotibial Band / ITB is a very thick and strong structure and is essentially the biggest tendon in the body. The sheer size and strength it make it extremely resistant to tears and strains. In addition, the muscles that it is an extension of around the hip are so robust that they are not prone whatsoever to injury when they are in a healthy state. But there are limits to all physical tissue, and the Iliotibial Band / ITB is no exception.

Because of the way it tracks down the outside of the thigh and doesn’t cross any joints the Iliotibial Band / ITB is far less susceptible to things like sprains than many other connective tissue structures. The ITB band is prone to direct impact or blunt force type trauma. The classic ‘knee to the thigh’ moment that happens to many sportspeople at one time or another is an excellent example of this. Road traffic accidents are another time when direct force can impact the Iliotibial Band / ITB.

We meet a number of patients who develop Iliotibial Band / ITB issues years after an injury they sustained. In these cases, the patient usually has found that the bruising and pain of the original injury settles – only to later return as stubborn Iliotibial Band / ITB pain. Issues like this can take place over years – and the reason is always scar tissue.

If your Iliotibial Band / ITB pain is being caused by a legitimate Iliotibial Band / ITB injury it will almost certainly have been quite a significant event. Most Iliotibial Band / ITB pain cases caused by Iliotibial Band / ITB injuries are characterised by significant pain when running or walking and, a good deal of tightness.

Iliotibial Band Caused By Scar Tissue 

Scar tissue is most well known for its obvious and visible work, resolving wounds to the skin after trauma. Scar tissue is less well known for the work it does deep inside the body in response to stubborn stress and internal injuries. 

If you have had stubborn or recurring Iliotibial Band / ITB pain it’s possible that you have a scar tissue component to your condition. IT Band pain caused by scar tissue is often the same as Iliotibial Band / ITB pain caused by injury, but not always. Scar tissue can develop slowly in the body due to movement issues. Scar tissue is a part of the way our bodies deal with many kinds of ‘overloading’. 

Many persistent pain conditions including IT Band pain have a scar tissue component. If for eg. you spend many years working long hours on hard concrete floors – it places unnatural stresses on the joints and soft tissues of the entire leg. Over time the body reacts to the persistent strain and scar tissue begins to form through the soft tissues of the hip and thigh. This may be felt as Iliotibial Band pain, and stiffness. This type of process is the body’s way of reinforcing itself against persistent or excessive strain. 

Your body’s ability to elicit an inflammatory response is essential to its survival – it’s part of how we heal –  and yet if it is over-activated it can be a damaging and destructive force. Scar tissue is exactly the same, it is essential for bodily repair in general –  but too much of it can be an issue that plays a significant role in chronic stubborn ITB pain – and many other pains besides.

IT Band Syndrome Caused By Bursitis

The is fake news o’clock – bursitis can’t really cause ITB Pain – but it’s possibly that ITB Pain may cause bursitis. 

Bursae are ingenious fluid filled sacs that your body uses to reduce friction. The basic purpose of a bursae is to prevent damage at high friction points in the body. A bursa is a super smooth sack of fluid between layers of tissue that will reduce the friction. A bursa is not unlike a ball bearing –  in that it’s a lubricated sphere that prevents friction within a larger mechanism. 

Bursitis around the hip that relates to tightening and pain in the Iliotibial Band / ITB  comes from the irritation of an unhappy bursa. There are two major bursae in the hip that are prone to irritation in humans like you. One covers the bony point out by your hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis. The other is called the  iliopsoas bursa –  located more towards your groin region – which can also cause hip pain and groin pain. It the Iliotibial Band becomes tight it causes extra friction – this can cause the bursa to become enlarged and inflamed.

If you consult the many many medical web pages, you will often see bursitis referred to as a ‘cause of  pain’. It’s important to interpret this carefully given that bursitis is merely a reaction to some form of ‘underlying strain’ – rather than a condition in and of itself.. 

Whatever is causing strain in the IT Band is the true ‘cause’ of the bursitis and ITB pain we suffer with. We frequently see people in our clinic who suffer from hip bursitis and IT Band pain because they have extremely weak gluteal muscles and flat feet for example. 

IT Band Syndrome Caused By Arthritis 

Degenerative disorders like osteoarthritis are a common part of the persistent hip and thigh pain in older patients. Osteoarthritis is the medical term for cartilage degeneration inside the hip joint. Many older people (and even some younger people) with hip osteoarthritis also have IT Band pain. Often their ITB pain is overlooked and simply blamed on the osteoarthritis, however – leaving the poor person walking around with pain that could easily be treated.

The provision of healthcare for conditions like osteoarthritis is quite poor compared with many other conditions. In the U.S. research has shown that the average length of a ‘pain consultation’ at doctors’ offices for older people is less than 3 minutes. For perspective – when older patients come to our clinic in pain their initial consult is over 40 minutes. If you have stubborn hip/thigh/ ITB Pain combined with osteoarthritis – the best plan is to seek professional advice from multiple trained sources and perspectives. 

Many patients with hip and knee osteoarthritis find that once they have some intensive rehab work done on the soft tissues in their leg – much of the pain they had thought was joint pain reduces. Diagnosing and proactively managing the underlying movement imbalances that cause one hip to wear out and the other to prevail can also be a huge help to hip pain and ITB Pain sufferers. 

IT Band Syndrome Caused By Diet

A relatively small percentage of IT Band Pain sufferers ultimately find that a major contributing factor in the generation of their pain is some food intolerance or other. If diet is a significant factor in your ITB Pain it’s likely you will also have persistent pains in multiple other areas. If you have multiple areas of stubborn pain in your body it is worth considering the possibility of an issue in the gut, and how it processes certain foods.

Intolerances like gluten intolerance and salicylate intolerance can easily contribute to stubborn ITB pain – and many other pains besides. Given the sheer number of people who find relief from pain when they consume supplementary fish oils and turmeric it’s also safe to assume that nutritional deficiencies have their part to play in many cases.

If you have persistent ITB pain it is safe to assume that on some level it’s mechanical – not always – but nearly always. If however, you’ve struggled with successful ‘mechanical treatments’ and/or you have multiple areas of pain in addition to your hip it may be worth considering the possibility of dietary influences. 

IT Band Syndrome Caused By Internal Organs

There are a vast number of complex connections within the human body. A part of the body in which there is a great deal of complex connectivity is obviously the nervous system. You can have pain in your neck and feel it as a migraine (cervicogenic migraine), you can have pain in your back and feel it in your leg (sciatic pain), you can also have pain in an internal organ and feel it in your hip and thigh… 

Multiple organs including the gut and reproductive system can refer pain to the hip and leg region. If you have ‘ITB Pain’ that’s resistant to treatment you may have some undiagnosed ‘referred pain’ from an organ. It should go without saying that you should always seek qualified professional help if you require a diagnosis for your pain.

IT Band Syndrome Caused By Stress & Emotional Issues

We have yet to even begin truly understanding the full complexity of many things the body does – but you can be confident that many things that go wrong are more to do with our emotional well being than anything else. Especially in the pain arena. Consider how many of us have noticed a connection between our stress and our shoulder/neck pain for example. Stress creates a huge amount of muscle tension in the body, it also alters our posture and the way we move.

In reality, there are a host of emotional patterns that lead to pain complaints almost anywhere in the body This spectrum of issues can be triggered by anything from intense childhood trauma to mild but stubborn stress. The timing of pains onset is often triggered by stress and emotional issues too. The world’s most standard types of pain like biomechanical back pain and ITB pain often hurt way more when we are stressed.

 If you have pain in your IT Band areas or any other area for that matter – and all your scans and tests come up all clear medically – it’s entirely possible that there is some underlying trauma or build-up of stress that plays a part in your pain. If you find that your IT Band pain becomes worse or came on during a stressful period you can also be fairly sure that there is at least an emotional component to your pain.