I see what this woman is doing in the video all the time at the health club, people rolling out the side of their hip. You’ve probably seen it, too, or, perhaps, you are one of those people. So why are they doing it? It’s not because it’s a new fitness fad; it’s because after working out, the side of their hip hurts. The commonly prescribed method for providing some relief is stretching and self-massage; however, this is only a temporary solution in some patients and doesn’t address the real problem.
So what exactly is causing this pain in the side of the hip, and how do we fix it?
The ITB and How It Can Cause Pain in the Side of the Hip
There are many muscles that make up the side of the hip, and these connect into a large piece of tough connective tissue termed the iliotibial band (ITB). Breaking this word down, ilium refers to the hip, and tibia refers to the knee. And, indeed, the ITB stretches from the side of your hip all the way down to your knee (watch the brief video above to see a labeled image of these structures in the side of the hip).
When the muscles around the ITB get tight (e.g., the gluteus maximus), such as with exercise, this tightness yanks on the ITB and causes tension and pain. Side-to-side changes in the body’s symmetry can also irritate the ITB. An example of this would be scoliosis, where the spine is curved to the side. Other problems in the low back, such as a dysfunction or pain in the SI joint, can cause chronic ITB tightness. The low-back nerves that supply those hip muscles that insert into the ITB can become pinched or irritated and this can weaken the hip muscles and overload the ITB.
Other issues that can irritate the ITB include knock knees, bow-leggedness, and a snapping ITB, where the ITB experiences friction as it passes over the greater trochanter part of the femur.
Treating the ITB
When stretching and massage fail to fully address the pain in the side of the hip caused by a chronically tight ITB, some people will turn to surgery. This is called ITB release, but this surgery is a bad idea. The goal of the surgery is to weaken the tendon so that it lengthens and then heals. Surgeons accomplish this by cutting small lines in or a piece out of the tendon (usually near where it attaches at the side of the knee). Unfortunately, however, an ITB release can destabilize the knee, throwing the structural balance out of whack and creating a domino effect of problems over time.Advanced platelet rich plasma (PRP) and stem cell injections precisely placed into the ITB have been successful in many of these patients, but it’s very important to treat the cause as well, not just the ITB. If the patient isn’t complaining of back pain (and there can be a problem in the back without associated pain), the back isn’t even looked at. Interestingly, oftentimes the only indication that there’s a problem in the spine is the issue in the ITB, so the symptom needs to be traced back to its source. Unfortunately, many providers never look this far. If this is the case, how do you help this problem? We often use our advanced platelet lysate injected around the irritated nerves.
The upshot? Just because you don’t have back pain doesn’t mean you don’t have a spine problem causing your pain in the side of the hip. When ITB stretching and massage get to the point where they are only providing temporary relief, your pain in the side of the hip is likely more chronic, and it may be time for a PRP or stem cell treatment.