Many recreational and professional athletes complain of lateral knee pain commonly blamed on IT-band friction syndrome. It’s generally considered an overuse injury but, if so, why do some have it and others don’t?
A varus (bowed) knee from excessive supination on the ipsilateral leg or pronation on the contralateral side is a common culprit (figure 1). Notice how true IT-band friction syndrome typically manifests on the dominate leg. Those of you who’ve read the Short Leg Syndrome articles on my website will understand my take on this motor dominance issue.
In my soon to be released 6-DVD set titled Myoskeletal Engine for Back, Leg and Foot Pain, and in the September issue of Massage Today Magazine, I describe a condition called the Stirrup Spring System (SSS) Syndrome that commonly disguises itself as IT-band friction pain. The SSS theory is based on the assumption that the human body relishes energy conservation and therefore, possesses a recovery pulse to avoid loss of kinetic (movement) energy into the ground during walking and running.
Notice in Figure 2, that when the hip extensors are maximally stretched, a dynamic pull travels down the lateral leg and tugs on the tibialis anterior/peroneus longus stirrup.
Heel strike during running activates this antigravity stirrup system and delivers energy back up from through the biceps femoris and sacrotuberous ligament where it combines forces with other muscles to rotate the sacrum and pelvis and counter rotate the lumbar spine (figure 3). When working in perfect harmony with the other three spring systems (described in the Don’t Get Married article on my site), it winds-up the intervertebral joints and deep ligamentous structures creating the smooth cross-patterned gait we’re used to seeing in highly functioning individuals.
However, if the soles of the shoe are too cushioned or the running surface is too soft, i.e., sand, the tib anterior and peroneus longus stirrup can’t quite raise the arch and, therefore, is unable to properly distribute ground forces up through the biceps femoris and sacrotuberous ligaments to help secure the sacrum on the ipsilateral side. In an effort to get this stirrup spring system going, the biceps femoris must exert greater force to elevate the arch and this is where the problems begin.
Because the distal attachment of biceps femoris attaches to the proximal fibular head, prolonged tractioning results in posterior displacement of the fibula in relationship to the tibia. Some assess the problem as IT-band syndrome, some think it’s a lateral meniscus problem, and some blame the lateral collateral ligament.
You can test the SSS syndrome by flexing the knee and placing the foot flat on the table. Grasp the fibular head and attempt to move it anteriorly and posteriorly. There should be movement here (joint play) and, if not…fix it. For right leg dysfunction, web your left hand in the popliteal space and bring the knee into flexion with your right hand holding the foot.
Flex to the first restrictive barrier and ask the client to GENTLY raise their foot against your resistance to a count of five and relax. Bring the knee into more flexion while your webbed hand acts as a wedge to push the posteriorly displaced fibular head anteriorly. Repeat 3 to 5 times and recheck for improved joint play. Finish by balancing all lower quadrant structures.