Youth: The Overlooked Knee Injury that Puts a Cap on Soccer Performance

***This article is part of an educational series for soccer parents and players new to soccer***

In the world of soccer injuries, concussions have been hogging the spotlight. After all, the rates of injury have risen steadily, and new research continues to emerge regarding how serious they can be. But there are other injuries that can take players by surprise. 

One such injury is Iliotibial band syndrome (IT band syndrome). It can cause significant discomfort and sideline the toughest players. With that said, the purpose of describing this injury isn’t to put fear into you, but rather, to raise awareness and help you prevent it from happening. Here’s what you need to know:

IT Band Syndrome: A Deeper Look

IT band syndrome is a very common knee injury, that’s caused by overuse and repetitive flexion and extension of the knees. The injury occurs when the IT band gets tight, irritated and inflamed. This resulting tightness leads to friction and pain outside of the knee when one bends it; which we don’t need to tell you is uncomfortable and detrimental to optimal soccer performance. 

The iliotibial band (IT band), also known as the iliotibial tract or Maissiat’s band, is a long piece of connective tissue, or fascia, that runs along the outside of your leg from the hip to the knee and shinbone. The IT band allows you to extend, abduct and rotate your hip; motions which are essential for several key movements in soccer. 

Causes of IT Band Syndrome

As we mentioned above, excessive friction causes IT band syndrome and it is a type of overuse injury. Some people are at an increased risk for the condition based on various factors including:

• Weak core muscles (hips, gluteals, and abdominal muscles)
• Lack of flexibility
• Excessive sitting
• Weak knee extensor, knee flexors, and hip abductors
• Arthritis of the knee
• Unequal leg lengths
• Flat feet
• Bowlegs
• Worn-out or unsuitable training shoes 
• Sudden or excessive increase in hill training
• Athletes who execute repetitive motions

Soccer players are constantly putting pressure on their knees whether it’s bending and extending the legs for a kick, or rapidly cutting direction with high bursts of speed. The knee joints and its surrounding tissue can handle a lot of strain, but with the increase in training volume and playing time, many players are putting too much pressure on these joints. Only when they experience pain outside of the knee along with other symptoms, do players realize they’ve pushed themselves too hard.

IT Band Syndrome in the Flesh: Symptoms of the Injury

• Pain outside of the knee, especially when the player stands with his or her full weight on the joint
• Pain when going downhill and level ground running or jumping (which is more severe when the foot hits the ground)
• Pain during early knee bending 
• Pain that worsens with the continuous running or other repetitive activities
• Stiff leg 

These symptoms become more severe if a player pushes through it, or doesn’t address their pain right off the bat. That’s one of the reasons why it’s absolutely vital that you treat these symptoms early and more importantly, try to prevent IT band syndrome before it occurs. 

How Can Soccer Players Get a Case of IT Band Syndrome Treated

First off, it’s important for players, parents and coaches to recognize the symptoms mentioned above. If they’re present, don’t ignore them! It’s crucial to get a diagnosis so that the player can get the right treatment immediately. 

A sports physician will make the diagnosis of IT band syndrome with a patient interview and physical examination, which is usually enough to diagnose the condition. However, the physician may still request an ultrasound, X-ray or an MRI scan if he suspects that other injuries may be at play. 

If a player gets a positive diagnosis for IT band syndrome, then they will likely need the following treatment plan. 

IT Band Syndrome Treatment for Soccer Players

• Persistent icing and resting of the area during the first week after initial symptoms 
• Daily stretching 
• Muscle-strengthening exercises
• Non-steroidal anti-inflammatory drugs (NSAIDs such as Ibuprophen, Acetominophen)
• Surgery for very severe cases 

The extent to which these treatments will be necessary for a player will depend on the extent of their injuries. Of course, the longer the player has to wait before they receive treatment, then the more severe their IT band syndrome will likely get, meaning more intensive therapies. 

Preventing IT Band Syndrome in Soccer Players

Now here’s the most important thing to remember about IT Band syndrome: it’s impossible to fully prevent it from happening, BUT, the majority of IT band cases can be avoided. Let’s revisit the causes once again. 

With the exception of genetic issues (ie. leg length differences), most of the causes of IT band syndrome are related to muscular weaknesses, overtraining/overexertion and improper use of equipment. All three of these factors are factors that coaches, players and sports physicians can address before they become problematic. 

Training Weak Core Muscles Can Prevent IT Band Syndrome

Remember, muscles, tendons, ligaments and joints function as a chain; and as the cliche goes, you’re only as strong as your weakest link. Weak core muscles consisting of: gluteals, hip abductors, thighs and the abdominal muscles, all contribute to IT band syndrome. 

When these muscles are weak, they’re unable to assist muscles and tissues throughout the body, forcing the player to overuse those tissues. The key, of course, is to train and strengthen core muscles so that they balance out the exertion other muscles give out. 

With that said, all soccer players including the youngest ones should engage in some form of core training. Effective soccer stretches for players include: 

• V-Ups
• Front & side planks
• Ab rows
• Alternating leg raises 

Older youth and young adult players can incorporate weight training into their routines to increase their core strength. On top of that, it’s important for players to maintain a good warmup routine so that they’re not going into a game unprepared. 

Decrease Players’ Training Load and Field Time

Over the years, there have been more articles talking about a growing epidemic in soccer, and this is players who participate in too many games. It’s not uncommon for players who are just 8 or 9 years-old to play as many as 60-80 games per year, which is too much for some. In a 2016 NYTimes article, retired American and record-holding goalkeeper Brad Friedel said that players in the optimal age range of 23 to 29 years old can play up to 50 games. But Friedel said this: “The problem is with the increases in group stage play and qualifying for various tournaments, the number of games just keeps going up.” And it’s contributing to more severe injuries and general burnout among players. 

The lesson here for coaches is simple and vital: don’t overwork your players. Give them adequate time to rest in between games and practice sessions, and rotate them frequently so that they’re not overexerting themselves. Also, if a player appears to have to be playing at reduced effort or intensity, quickly assess and rest them to avoid a full-blown injury. 

The Right Soccer Equipment (and Use) Can Reduce IT Band Injury Risk

Last but not least is the issue of soccer equipment: IT band injuries partially arise due to repetitive impacts. This means as much effort should be made to protect body tissue from sustained forces. In addition to proper training and rest, the use of “shock-absorbing” gear can reduce the amount of force placed on the knees. 

For starters, products such as our BodyShield Knee Guards are formulated with impact protection. Essentially, this reduces the strain on the knee joint and surrounding tissue when players bend and extend the knees for kicks, dekes and more. 

Additionally, the right choice of insoles can help players as well. For example, our SpeedGrip® insoles increase foot control, which naturally provides added foot stability. When players run and cut suddenly without proper stability, it can damage already weak knee tissue. Our insoles give the foot more stability so that the knees don’t endure too much strain. 

IT Band Syndrome: A Troublesome But Preventable Injury

IT band syndrome and the pain it causes outside of the knee can leave the toughest players sidelined for weeks or months. It’s a miserable injury, and the pain can strike almost randomly. However, it can be prevented in many cases, with recovery also being manageable. It just means the right conditioning, equipment and load management is necessary so players don’t buckle under the pain of IT band syndrome. With the points of this article in mind, the proper attention and energy can be focused on the game, your next play and the next tournament; rather than on the sidelines nursing a sore knee.