A Few Thoughts on Rehabbing IT Band Syndrome

On the outside of the knee, between the iliotibial band and the insertion of the vastus lateralis, there's a gap you can see clearly on an anatomy chart.

That gap holds some fatty tissue, which you can also call a fat pad. In general, the pain of iliotibial band syndrome¹ comes from the knee compressing the fat pad underneath as it bends and straightens, which leads to inflammation.

Yesterday I took my MRI films to a rehab clinic to see the therapist Master Peng had recommended.

Until then, I'd never actually had a professional diagnose my IT band syndrome. He had me lie on the table and relax my legs, then moved my legs around like they were cotton wool, and finally told me, casually: "Yep, this is textbook IT band syndrome."

When I heard that, I didn't feel bad at all. If anything, I felt a bit relieved.

Because that one sentence settled two things for me. First, I hadn't misjudged it before. Second, IT band syndrome can definitely be fully healed with rehab.

Then the therapist started manual release. The very first thing he did was work on the spot I described at the start of this post, and I felt it incredibly intensely, because I'd never released that area myself at home.

To be honest, I wasn't surprised when he went for that spot. I'd seen videos online about releasing it and had tried it myself. I just never could feel anything when I did it, so I eventually stopped working on it.

The therapist, Mr. Zhou, worked that spot with his elbow for a very long time. It hurt so much I went numb, and of the whole manual release session, that spot hurt the most.

He told me I can actually release that spot at home with a massage ball. But in lower-body release, some muscles are hard to reach on your own, like the TFL.

I have to admit that a few days ago I posted that I seemed to be slowly finding where my TFL was. Turns out I was wrong. The TFL sits close to the ilium, so when you release it, most people feel like they're massaging bone.

But the TFL really does grow right along the edge of that bone. It's wild.

That one session at the rehab clinic also changed how I see a few things.

First, information online is a tangled mess. The internet could tell me I had IT band syndrome, but it was very hard to find the treatment that suited me best among the flood of methods out there. In a sea of information, judgment and decisions are sometimes hard to weigh.

Second, it's true that IT band syndrome comes from a weak glute medius and an overly tight TFL, and it's right to strengthen the glute medius. Where I went wrong was training without releasing the tight muscles first. I now clearly understand that training and release can't be separated. Good release is there so you can train better. If your muscles are already tight and you keep doing strength training, they'll only get tighter, and your strength gains will take twice the effort for half the result.

Third, release is right, but it has to be as thorough as possible. For the lower body, that means releasing every side of the thigh and calf: the quadriceps in front, the vastus lateralis on the outside, the vastus medialis on the inside, the hamstrings at the back and so on. You can't just release one side, or stop because it hurts too much.

While Mr. Zhou was working on me, I could clearly feel that the glute medius and upper vastus lateralis, which I release often, weren't especially tight or sore. The muscles I rarely release, or had never released at all, hurt and felt fuller and tighter than ever, like the piriformis.

After this session, I'm even more sure of my earlier conclusion: I'd just been too lazy. I wasn't proactive about release, and I wasn't proactive about training.

I wasn't even proactive about wanting to get better. It's only now, when I want so badly to go on a good ride, that I finally made up my mind to see a rehab therapist.

I have to say, leave professional things to professionals really is true. It's not that the therapist knows so much more. It's that a professional usually has a clear line of thinking in their head, and can quickly reach a diagnosis and build a plan around the specifics of each case. That beats me blindly searching for guides online by a mile.

Footnotes

1. Iliotibial band syndrome (ITBS): common in running, cycling and similar sports. It typically shows up as pain on the outside of the knee and is mostly related to repeated friction or compression between the iliotibial band and the tissue beneath it. ↩