T Nation

Illiotibial Band - ITBS and Squats

My first on the board.

This is a question for the more medically inclined on this board. I woke up this past Monday morning with incredible stiffness in my left knee. I thought the stiffness was due to the two beach volleyball matches I played on Sunday, so I just assumed the stiffness was a result of overexertion.

Then I noticed if I sat down and then stood straight up (as if I was performing a squat)I would feel a knot on the outside (lateral side) of my left knee. It almost felt like the knee was “grabbing” as I bent my leg and then as I straightened the leg I would hear a pop or cracking feeling. This has been going on for a week now.

The stiffness and swelling in the joint has somewhat subsided, but the annoying (and somewhat painful) popping/cracking persists (occasionally - particularly after sitting for too long). I have spoken to friends of mine regarding this problem (both are formal collegiate Division 1 athletes) and a respected physical therapist/triathelete.

My two friends think I have overstretched the ligaments in the knee (thus explaining the stiffness)and that I may have “loosened” the cartilage (causing the popping/cracking sensation)in the knee.

The physical therapist thinks I have ITBS (Illiotibial Band Syndrome a.k.a. Runners Knee)and that a stiff ITB is causing the pain (I showed him the spot where I was felt the pain and stiffness. He stretched the ITB for me and it did feel better, but the popping/cracking still occasionally persists. I found the ITB diagnosis odd, because I am not a big runner. In fact I have not run distances of any kind since I was in my early 20s, but I LOVE to squat.

BTW, this injury is similar to an injury I suffered in my early 20s: I was squatting one day in the gym, with about 225 on the bar (not a heavy weight for me at that time) and I was coming down to parallel my right knee bowed out to the right and I felt this sharp pain that started in my knee and then shot up towards my him.

I should have stopped the set right there, but in a moment of stupidity, I kept squatting and completed the set. I felt numbness and stiffness in the knee, which persisted for the next few days. I went to an osteopathic physician and explained to him what happened. He told me to first, stop squatting it’s bad for your knees (SURPRISE, SUPRISE), and second, stay off of it. He then perscribed physical therapy, which I did for about 2 weeks.

Personally, I knew what caused the injury - bad form and poor flexibility. The doc. also told me my knee joint was very weak. I thought this was odd, because at the time I could knock out 20 reps with 330 lbs (down to parallel) in the squat. He told me the muscles around the knee were so weak that he could easily “knock” my knee cap out of alignment. He told me start doing leg extensions (with a reduced range of motion - I laughed out loud). He then stood up and pulled up his pants leg to show me how solid his quads were. I have to admit the guys legs looked solid.

Anyhow, I took a little of his advice, but I have continued to squat. The right knee occasionally pops, just like the left one does now. I think this popping in the right knee was definitely caused by this injury.

To give you all some background on me: I’m 30 years old (soon to be 31) and have been consistenly lifting for 13 years (i.e. lifting 4 days a week). At a height of 6’1" and 215 lbs (10 - 11% BF), I have a short torso and long legs (i.e. long upper thighs), so I don’t exactly have the ideal bodytype for squatting.

My questions:

  1. Has anyone dealt with knee pain such as this?
  2. How did you rehab from it? Exercises, supplements etc.

I haven’t worked my lower body in a week (just working upper body), because everyone has been telling me to rest my knee until my body tells me to give it a go. I was hoping someone could give me some advice on how to ease back into training the “wheels” again. THANKS

I have ITBS too, due to an old grappling injury and no proper rehab. Get the PT to show you how to stretch it, and get it massaged occasionally. Actually, one of those foam rollers works wonders for massaging it. It’ll feel a lot better.

Good luck.

I have experienced something very similar. The “weakness” was instability of the knee joint, and the grinding was a result of very tight quads. My coach/trainer/friend put me on a stretching program to loosen up everything, and some rehab/prehab stability drills. My best bet would be on Ian Kings Sport Specific fexability video series. His lower body(and upper) flexability recomendations are second to none.
His leg developement programs also kick ass. There are a few of those in the archives.

There is an article…on here…perhaps by Eric Cessey about buying a $10 foam roller and using it to stretch your iliotibila band (note: it will not be comfortable).

I think tight iliotibial bands (which pull your kneecap to the outside) and weak vastus medialis (inside quads) which fail to counteract the pull of the iliotibial bands, are the source of much knee evil.

Foam roller work on the IT bands is very effective, but I would also focus on the trigger points you undoubtedly have above the hip socket. You’ll find some very tender spots there. The ITBS is the symptom, they are the root of the problem.

I’ve had some of the same things as the thread author said. Strangely enough, it happens after a good session of foam rolling and stretching, and I can make it subside. A little ligament or SOMETHING pops out in my left knee. It gives me a dull pain if I try to bend it one way or another. However, I find that when I push down on this actually visible thing popping out of my knee, it relaxes and the pain goes away. :open_mouth:

Regarding leg extensions, I’m really reconsidering the bad rep they have on this forum. I’ve had runner’s knee issues that are slowly but surely getting better, and I went on CT’s “Pillars of Strength” leg program, which uses single-leg extensions on one day and regular leg extensions on another. The single-leg extensions are followed by Bulgarian Squats, an exercise that was typically painful for my knees. After banging out the leg extensions though, no pain in the subsequent exercise.

Last night the effect was even more impressive. Front squats seem to aggravate my knee pain more than back squats. On the 3rd leg day, you do alternating 3x8 front squats and 3x15-20 Leg extensions. I banged out a pretty painful set of front squats, rested 90 seconds, then did 20 leg extensions where I almost failed on my last rep. After the 90 second rest, I did my second set of front squats, and there was ZERO pain in my knees.

I don’t know what it is, perhaps the leg extensions get my VMO firing properly or something, but it has really been remarkable. I’m even thinking about throwing in a low-weight, high rep set of extensions before I do back squats next time.

I’ve been diagnosed with something different by each doctor I’ve been to. What I know for sure is this: If I run for more than 25 mins, more than once a week, my left knee kills me (going to the movies isn’t that much fun either). I have pretty flexible calfs, quads and hamstrings, but my left leg is less flexible than my right (!!). I had this problem for 3-4 years before I tried to do something about it.

Lots of stretches (as recommended by my physio), full ROM squats (as recommended by Charles Poliquin, I think)…and single-leg extensions!

One thing is for sure: my left VMO is smaller than my right one. Leg extensions with just the last third or so of the movement, with the foot pointing outwards, really target the VMO. I do them after squats and deadlifts, but I might consider doing them afterwards, as PublickStews does.

Gridiron, I also have something that goes pop in my knee. Just before I get down to parallel I feel it, like a tendon snapping into place or something. I stretch my knees before any leg work, which seems to lessen the popping, and sometimes I can hardly feel it at the end of the session…but it’s always there. My podiatrist told me that as soon as I get corrective insoles (I overpronate) the popping will go away, but she didn’t really explain to me why it happened.

Maybe the only thing worthwhile in my whole, long-ass post is that I was told not to squat by just about everyone (docs included). Well, I did/do squat, and I have had no knee pain asociated with it. The only pain I get is sore muscles :slight_smile:

OK, so I did a quick search in my bookmarks and found the bit about strengthening the VMO:

Vastus Medialis Oblique (VMO)

This muscle is one of the four that make up the quadriceps. So, you do lots of leg extensions and leg presses you say? Sorry, eventhough the VMO is worked in these movements I never find it adequate in developing VMO strength. How do I know? Simply watching someone squat can tell a lot, you can see flexibility problems and strength imbalances. It is very common to see the knees buckle as someone descends into the squat position. Yes, this can be caused by other problems, but that is why I perform several tests to confirm this initial finding. The knee will also tend to buckle on several other exercises such as step-ups, or split squats.

So, what is the big deal of not having a very strong VMO? There has been plenty of research to show that one of the primary purposes of the VMO is to maintain proper tracking of the patella. When there is an imbalance between the VMO and the vastus lateralis (the outer head of the quadriceps) the patella is moved out of place causing a great deal of pain within the knee. This is usually seen as a chronic problem, meaning, it will be a problem that slowly develops and the pain will not be immediate. A lack of VMO strength could also potentially be the reason of an ACL injury.

The remedy? Perform progressions such as step-up and split squat variations. Once you have developed the proper strength from these progression you may perform full squats. One of the many reasons full squats are extremely beneficial is their ability to develop the VMO. Going to the full squat position places the VMO is a fully stretched position under a load. World Renown Strength Coach, Charles Poliquin, has often spoke of his ability to cure knee problems of athletes just by utilizing full squats and their variations.

Hey, I don’t know about you guys, but if Charles tells me to squat my A to the G, I’ll do it!

Thanks for the responses. Very imformative.

I am certain we are not the only ones on this board who suffer with this problem.

PublickStews/Miserere: I have experimented with Leg Extensions as well. However, it was my understanding that if you want to target the VMO you need to reduce the ROM on Leg Extensions to the bottom 1/3 of the movement.

Miserere it sounds like you have Patellofemoral Pain Syndrome. I have this in my right knee. The condition is aggravated when the feet roll in or pronate. Athletes who do a lot of long distance running usually suffer the most with this condition.

Also, excessively tight calf, quads (especially vastus lateralis), hams, and ITB can exacerbate the problem. In my initial post I explained that I have a patella tracking problem in my right knee. Miserere the popping feeling you are experiencing may be due to a tracking problem. The doc. I went to prescribed a sports kneebrace called a “J-bar” brace. I have been using it regularly for 5 years. It has definitely helped with the tracking problem. It took a little time at first to get used to it, but it may help you out. In addition, most experts strongly recommend that you rest until there is no pain (may be tough to do for guys like us).

My fiance has one of those foam rollers for her back, so I am going to search around for Cressey’s article on stretching the ITB. I am also going to start taking Glucosaimne Sulphate along with Chondroitin. I really believe the problem in my left knee stems from ITB friction, where the tendon is actually rubbing on the bone at the knee (I think this is what is causing the “popping” sensation in my knee.)

Try to find a good Massage Therapist that specializes in Trigger Point Therapy. Have them concentrate on the Psoas muscle and the Rectus Femoris, after that, have them work all of the Quads, Hams, and Ab and Adductors. Also, have them check your calves and glutes just in case. Many times, joint tracking problems are related to trigger points which shorten the muscle fibers involved, thereby causing the affected muscle to stay in a contracted state.

Hiya Gridiron,

[quote]Gridiron wrote:
Thanks for the responses. Very imformative.

I am certain we are not the only ones on this board who suffer with this problem.[/quote]

You bet! There’s a knee pain thread somewhere on this site, but it’s got hyyuuuuge :slight_smile:

I’m not sure what you define as “bottom,” but my understanding was that it was the final 1/3 ROM that activated the VMO most (also why they recommend step downs as an exercise). I go for 20 reps, with my foot pointing out a bit, and the only muscle burning in my leg is the VMO.

I know!! :frowning: Mine became a chronic problem when I began training for a half-marathon some 7-8 years ago. I overpronate, but never knew it, so I was wearing completely the wrong shoes for my feet. Only got properly diagnosed about 18 months ago; have hardly been able to run, but this has made me more serious about weight lifting so although my knee is progressing slowly, I’m enjoying lifting weights at the moment. However, I would love to be able to run and play basketball again, eventualy.

We got two good legs between us, then :slight_smile: My bad knee is the left (my jumping leg from basketball days).

The strange thing is I hear/feel it on the outside, and behind, my knee, nowhere near the patella region!

Hey, is 7-8 years enough? :wink: I’ve got a brace too, but without a fancy name, so maybe that’s why it doesn’t do much. The problem I have with braces is that they are aimed at solving the pain, not the problem. My patella doesn’t track correctly because of a weak VMO; this is clear as you can compare my left and right VMOs and the left one is maybe 30% smaller. Over pronating doesn’t help either; I’ve got insoles to solve this problem, and now I’m working on strengthening my VMO to get everything in place, finally.

I was thinking of getting one of those rollers too. Do let me know if it does anything for you (PM me if you like). I’ve added ITB stretches to my routine since seeing a physiotherapist last year, and maybe that has helped me. I’ve also been taking Glucosamine and MSM for a few years now, and just added Chondroitin too. I’m not sure if any of it has helped, or if it’s been the rest, or the rehab…but just in case I’ll keep on taking them. Fish oils are also recommended for joint issues.

Seriously, let me know how you do!

Miserere - I’ll definitely keep you posted. I have begun to use the roller (man is it PAINFUL) and I have already noticed a slight change in the left knee. So maybe we are on to something. I will also incorporate ITB stretches.

I will post again under this thread in a month to keep you posted on my progress.

In the meantime, I noticed Mike Robertson has started a thread on knee pain. I plan on dropping a post on that thread since I know Mike is very knowledgable in the area of pain management.

I’ll see ya in a month.

Thanks again for the solid input.

ok so what do we do about a tight or weak IT band?