Acupuncture for IT Band Pain
A person with lateral knee pain or IT band syndrome pain
Acupuncture and Dry Needling: An Effective Approach to IT Band Syndrome
As a leading acupuncture clinic in New York City, at Morningside Acupuncture, we're passionate about using traditional techniques for modern healing. We specialize in acupuncture and dry needling, two powerful tools in treating a condition commonly seen in runners, cyclists, and hikers: Iliotibial Band (IT Band) Syndrome.
What is IT Band Syndrome?
IT Band Syndrome (ITBS) is a common overuse injury that affects the iliotibial band - a long, thick band of fibrous tissue that extends from the hip, down the outer thigh, and attaches to the shin bone (tibia). This band works in tandem with several muscles to provide stability to the outer knee during movement.
When the IT band becomes inflamed, typically due to overuse, it can cause painful symptoms along the outside of the knee, often mistaken for a knee injury. The pain typically worsens with activity and eases with rest, but without treatment, it can lead to chronic discomfort and limit physical activity.
IT band syndrome is the second most common running injury after patellofemoral pain syndrome so if you are an avid runner it is likely you will encounter ITBS at some point.
Causes of IT Band Syndrome
IT Band Syndrome is often the result of poor training habits, improper biomechanics, or muscle imbalances. Overworking your leg muscles, quickly ramping up mileage, running on uneven surfaces, or consistently running downhill can put excessive strain on the IT band. Furthermore, muscle weaknesses in the hips and core can also contribute to ITBS, as these areas play a crucial role in maintaining proper leg alignment and movement.
The Role of Acupuncture in Treating IT Band Syndrome
Traditionally, IT Band Syndrome treatment has focused on rest, pain medication, and physical therapy, but these methods may not always provide sufficient relief or prevent reoccurrence. This is where acupuncture, a method with roots in Traditional Chinese Medicine, offers an innovative approach grounded in science.
Acupuncture stimulates the body's healing processes by activating specific anatomic sites, often referred to as acupuncture points. Clinical research has shown that stimulating these points can release endorphins and activate the body's natural painkillers, reduce inflammation, and improve local blood circulation, all of which promote faster healing and pain relief (Zhao, 2008).
In the case of IT Band Syndrome, acupuncture can target points that correlate to the pain area and the underlying muscles contributing to the condition, like the tensor fasciae latae (TFL) and gluteus muscles. By doing this, acupuncture not only treats the symptoms but also addresses the root cause, providing more holistic healing.
Dry Needling: A Specialized Acupuncture Technique
While acupuncture is often associated with a whole-body approach, dry needling, an acupuncture technique, is a more localized treatment. It involves inserting an acupuncture needle directly into myofascial trigger points, often described as 'knots' within the muscle, which are typically sensitive and can cause referred pain.
In a study by Kalichman (2010), dry needling was found to be effective in reducing myofascial pain and improving the range of motion. In treating IT Band Syndrome, dry needling can be applied to the TFL, gluteus, and other muscles in the hip and thigh area that may be contributing to IT band tightness.
While both acupuncture and dry needling have their individual benefits, utilizing them together can provide a comprehensive approach to treating IT Band Syndrome. A study by Tough (2009) has even found that the integration of traditional acupuncture and dry needling into a treatment program resulted in reduced pain and improved function in patients with chronic knee pain.
Trigger Points and IT Band Pain
According to Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, myofascial trigger points in the Tensor Fasciae Latae (TFL) and the Gluteus Maximus muscles are frequent causes of pain that is attributed to the Iliotibial (IT) Band.
The TFL muscle, which is on the front and side of the hip, and the Gluteus Maximus, the large muscle of the buttock, both attach to the IT band. When these muscles are overused or stressed, they can develop trigger points that refer pain to the IT band area.
The IT band itself, being a thick band of connective tissue, doesn't develop trigger points but can become inflamed (IT band syndrome) due to the tension and stress from the muscles that attach to it, especially if those muscles have active trigger points.
The referred pain from the TFL and Gluteus Maximus trigger points can mimic the symptoms of IT band syndrome, causing pain on the outside of the knee or hip. That's why it's essential to examine these muscles and address any trigger points in the treatment of IT band syndrome.
The Travell and Simons manual also provides detailed instructions on how to locate and deactivate these trigger points using techniques such as dry needling and manual pressure, which can provide significant relief from IT band pain.
More on the Anatomy of the IT Band
The IT band, also known as the iliotibial tract, is a thick band of connective tissue that extends from the hip to the knee on the outside of each leg. Despite its colloquial naming as a 'band', it is not a separate structure but rather a thickened lateral part of the fascia lata, the deep fascia of the thigh.
The IT band originates at the iliac crest, which is the uppermost edge of the hip bone, or the ilium. From this starting point, it extends down the side of the thigh, crossing the hip and knee joints, and finally inserts at the top of the tibia (shin bone), just below the knee, known as Gerdy’s tubercle.
Regarding the muscles that directly attach to and act on the IT band, there are two major muscles involved: the tensor fascia lata (TFL) and the gluteus maximus.
The TFL is a small muscle located at the front of your hip. It attaches to the IT band, and when it contracts, it creates tension in the IT band, aiding in the stabilization of the knee during standing, walking, and running. The TFL also plays a role in flexion and medial rotation of the hip.
The gluteus maximus, the largest muscle in the body, partially attaches to the IT band. It plays a crucial role in extending and laterally rotating the hip, and also assists in stabilizing the IT band.
Given the crucial role that these muscles play in relation to the IT band, they are often a focus in treatment strategies when dealing with IT band syndrome. Issues such as weakness or imbalances in the gluteus maximus and TFL can contribute to excessive tension in the IT band, leading to pain and discomfort. In such cases, targeted acupuncture and dry needling to these muscles can help to alleviate tension, reduce pain, and restore healthy function.
Biomechanics and Iliotibial Band Pain
IT band syndrome is often a symptom of underlying biomechanical issues, including improper gait or exercise mechanics. Let's break down how this can happen.
Your gait refers to the way you walk or run, which is a complex interplay of various muscles, joints, and nervous system controls. Each stride involves a cycle of movements, including heel-strike, stance, toe-off, and swing. If there's an imbalance or misalignment at any point in this cycle, it can result in abnormal stresses and strains on your IT band.
For instance, individuals with overpronation, where the foot rolls excessively inward with each step, often experience increased strain on the IT band as the knee inwardly rotates too much during the gait cycle. Similarly, underpronation, or supination, can also lead to IT band syndrome as it may result in the knee being overly stiff and unable to absorb shock effectively.
In terms of exercise mechanics, improper form during activities like running, cycling, or resistance training can lead to IT band syndrome. For example, running downhill or on banked surfaces, or cycling with your feet turned in or out, can create abnormal pull on the IT band. In resistance training, performing exercises with poor form or using inappropriate weight can lead to muscle imbalances that contribute to IT band stress.
If you have weak hip abductors, particularly the gluteus medius, your hip may drop on the side of the swing phase when you're running, a movement pattern called Trendelenburg gait. This compensatory movement can put extra tension on the IT band. Strengthening these muscles can help alleviate IT band syndrome.
Similarly, a lack of flexibility in the hip flexors, quadriceps, or hamstrings can alter your movement patterns and place additional stress on the IT band. That's why flexibility exercises are often recommended alongside strength training for managing IT band syndrome.
Addressing these underlying biomechanical issues is a critical part of treating IT band syndrome. It's not enough to simply alleviate the pain – to prevent recurrence, it's necessary to identify and correct the improper gait or exercise mechanics.
According to studies by Fredericson et al., Aderem et al., and Ferber et al., addressing issues like hip abductor weakness and improper biomechanics in runners is critical in managing IT band syndrome. Acupuncture and dry needling, alongside physical therapy interventions, can play a significant role in correcting these issues, alleviating pain, restoring function, and preventing future injuries.
As a runner or athlete, you shouldn't have to accept pain as an inevitable part of your fitness journey. Through scientifically grounded approaches like acupuncture and dry needling, it's possible to address the root causes of IT Band Syndrome and foster a stronger, more balanced body.
These techniques not only provide immediate relief from pain, but they also aid in long-term prevention. By targeting muscle imbalances, tension, and weaknesses, they set you on a path to better biomechanics and healthier training habits. They can be incorporated into your regular training regime, helping you to maintain optimal muscular health and function while reducing the risk of injury.
It's time to let go of the notion that rest and traditional pain medications are the only solutions to IT Band Syndrome. Embrace the power of acupuncture and dry needling to revolutionize your recovery process and get back to doing what you love, faster and stronger than before.
To learn more about how acupuncture and dry needling can be a part of your healing journey, book an appointment with us at Morningside Acupuncture. Our team is dedicated to supporting you in your journey to optimal health and peak performance.
Over to you
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Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual. London: Lippincott Williams & Wilkins.
Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.
Janda, Vladimír. “Muscle Function Testing.” (1983).
Zhao Z. Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in neurobiology, 85(4), 355–375. https://doi.org/10.1016/j.pneurobio.2008.05.004
Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of musculoskeletal pain. Journal of the American Board of Family Medicine : JABFM, 23(5), 640–646. https://doi.org/10.3122/jabfm.2010.05.090296
Tough, E. A., White, A. R., Cummings, T. M., Richards, S. H., & Campbell, J. L. (2009). Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European journal of pain (London, England), 13(1), 3–10. https://doi.org/10.1016/j.ejpain.2008.02.006
Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome. Clinical Journal of Sport Medicine, 10(3), 169–175. Link
Aderem, J., & Louw, Q. A. (2015). Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC musculoskeletal disorders, 16, 356. https://doi.org/10.1186/s12891-015-0808-7
Ferber, R., Kendall, K. D., & Farr, L. (2011). Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome. Journal of athletic training, 46(2), 142-149. Link
Charles, D., & Rodgers, C. (2020). A Literature Review and Clinical Commentary on the Development of Iliotibial Band Syndrome in Runners. International journal of sports physical therapy, 15(3), 460–470.
Hadeed A, Tapscott DC. Iliotibial Band Friction Syndrome. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542185/
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