ITB Lower Back Pain: Why Your Back Makes Your ITB Hurt

by Chris Centeno, MD /

itb lower back pain

About two-thirds of the back pain patients on whom I perform an exam have a fired-up and tender ITB. In addition, I’ve seen through the years that treating the issues in the back as well as the ITB works much better than just treating the back. Why? Because the ITB is the canary in the coal mine for back problems. Let me explain ITB lower back pain.

What Is the ITB?

The acronym ITB stands for iliotibial band. It’s basically the thickening in the fascia at the side of your thigh. In fact, you see people in the gym rolling out the side of their thigh all the time. So we all know that the ITB is an issue in many people.

A Little Deeper into Understanding the ITB

OK, so you know that the ITB is on the side of your thigh and that it hurts in many people. You also know that people roll it out to help with the pain. However, to really understand this bad boy, you need to know more.

ITB low back painThe ITB acts as a lateral stabilizer of the hip and knee. As you can see in the image to the left, the butt muscles (gluteus maximus—g max) and TFL muscles anchor the ITB as it runs down the side of the leg to the knee. So as you step on that leg with the other foot off the ground as you walk, these muscles and the ITB support your body. Without this support, your pelvis would collapse toward the foot off the ground.

What happens if these muscles at the side of the hip get weak? The tension on the ITB that’s there to hold your body up as you walk or run lessens. Hence, your ITB begins to get trashed as it gets yanked on repeatedly as you walk.

Given that nerves supply these muscles, if you have low-level nerve irritation in your low back (which you may not notice as back pain), the ITB muscles can begin to misfire and get slightly weak. The nerves that come from the lower part of the low back and go to these muscles are L4, L5, and S1. For more information on how this works, see my video below:

ITB Lower Back Pain: The ITB Is the Canary in the Low Back Coal Mine

In my experience, whenever these lower lumbar nerves are irritated, we see an issue in the ITB. It starts out as side-of-the-hip pain, and this area is extremely tender to palpation. In a few patients, it gets bad enough that they can’t sleep on their side at night.

So while this covers the lower nerves in the lumbar spine, what about other nerves in the low back? Can the upper low back nerves (L2, L3, L4) cause ITB issues too? Let’s explore that a bit.

The Vastus Lateralis and ITB

My personal trainer is a great student of anatomy, and we often banter back and forth. One of the things he relayed the other day is that he read a nice article on the relationship between the ITB and vastus lateralis (VL). This threw me for a second, but then I realized that he was right. The weird thing? I could find very little about this relationship online. Hence this blog.

What Is the Vastus Lateralis?

The VL is the outside-most muscle of the four muscles that make up the quadriceps. These muscles make up the big “thigh” muscle that you can see in the front. The muscle originates from the top of the femur bone and then passes down below the knee. The job of these muscles is to extend the knee.

Perhaps the more “famous” of these four muscles is the VMO, which is the vastus medialis. This is one of the muscles that physical therapists strengthen when someone has kneecap pain. It’s located on the far inside while the VL is on the far outside.

Why Few People Understand the Relationship Between the ITB and Vastus Lateralis

ITB and Vastus Lateralis

For the most part, medical providers tend to think that the muscle that underlies the ITB is the outside part of the hamstrings muscle, called the biceps femoris. It’s not. In fact, the ITB is simply a thickening of the VL fascial covering. What does that mean, and why is it critically important to why all of those people keep rolling their ITBs and why my patients have ITB issues?

Take a look at the diagram to the left. It shows that the muscle on the very outside part of your thigh is the vastus lateralis and that the biceps femoris is located behind the ITB. In order to really understand why all of this is important, you need to know more about how muscles work.

Muscles are surrounded by fascia. This holds them tightly contained and improves their ability to contract more strongly. In addition, the fascia around one muscle connects to the fascia around other muscles.

So What Does All of this Have to Do with the Vastus Lateralis?

The ITB is nothing more than a thickening in the fascia that surrounds the VL. If this muscle is not working well, the ITB will be impacted. In fact, looking at the cross-sectional design above, since muscles get larger as they contract, simply firing this muscle will cause the ITB to tighten. Hence, controlling the tension on the ITB happens through the two muscles described above (glutes and TFL) but also through the VL.

So what happens if the nerves that come from the low back are a problem? Meaning, if they’re irritated (with or without this patient having back pain)? The L2, L3, and L4 nerves go to the VL muscle, so the ITB will be impacted. You see what I’m describing here? The ITB is jacked into every nerve in the low back! So it doesn’t matter which low back nerve you have irritated, your ITB is likely impacted. Hence, the ITB is truly is the canary of low back problems! Meaning if you can’t get rid of ITB problems, then you need to get your back checked whether you have back pain or not!

Can This Type of ITB Problem Be Fixed?

Yes! While rolling the ITB and VL muscle can help your pain temporarily, if it persists, you need treatment. What works? First is an extensive hands-on exam and review of your low back MRIs. Once the culprit irritated back nerve is identified, we use our advanced fourth-generation platelet lysate precisely injected around the nerve using fluoroscopy guidance. See my video below for more information on that type of treatment:

The other thing that needs to be treated is the ITB and VL. We inject our high-dose platelet-rich plasma into these areas. On why that’s different, see my video below:

The upshot? If you have ITB pain, it’s likely ITB lower back pain, originating from your low back, even if you don’t have much day-to-day back pain. So take the hint from your body! If you need to roll out your ITBs more than occasionally, then see a Regenexx provider and get it fixed.

Category: Latest News

Leave a Reply

Your email address will not be published. Required fields are marked *

4 thoughts on “ITB Lower Back Pain: Why Your Back Makes Your ITB Hurt

  1. Frank Romeo

    I just had Dr. moova in Dallas use PL treatment on my lower back. In the last 2 weeks the results have been good. Should I query Dr. Moova about this? I had a torn ACL and MCL treated with Stem cells in March. It has worked very well. As you get older I’m 69 seems like you could benefit from PL in every joint. Is that possible?

    1. Regenexx Team

      Frank,

      We have a program called Regenexx Proactive based on that concept. Please see: https://regenexx.com/proactive/

  2. Diane

    Hi,

    I believe I have these problems! Is a MRI from 2 1/2 years ago good enough for someone to review. I was told my MRI has not changed much in many years. What would be the first step in resolving this? Any info would be appreciated!
    Diane

    1. Regenexx Team

      Diane,
      It could be a start, but diagnosis is based on exam and we’d need to examine you to confirm what’s going on in your case. The good news, is if that’s the issue, it is treatable.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.