Nix nasty outer knee pain

Stay off the sidelines and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The Injury: Iliotibial (IT) Band Syndrome. This band of connective tissue runs from your outer hip, along your thigh and to the outside of your shinbone. Every time you bend your knee more than 30 degrees -- say, when you run or ride a bike -- the band slides back and forth over the lateral femoral epicondyle, the small bony protrusion on the outside of your knee. When the band has enough slack, it's no biggie. But if it gets tight? That creates friction over the knee -- like starting a fire with two sticks. The result is inflammation and serious pain. Endurance athletes have more IT band grief because the band has to make that trip across the knee over and over and over. Women also may be more susceptible because their wider hips put the band under more tension with each stride.

What it really feels like: At its worst, think someone jabbing an ice pick into the side of your knee as you flex your leg. It's one of the more painfully debilitating overuse injuries.

Who's been there: Pro triathlete Donna Phelan (Team Sirius) first felt the stabbing pain in her right knee during a run in 2003, two weeks after racing Ironman Lake Placid. "It came on suddenly and ended my workout right there," she said. After getting no relief from massage, acupuncture or physical therapy, Phelan opted for IT band release surgery and resumed racing short distances in 2004. Five years later, on a run in 2009, her left IT band flared up. Same deal. Same surgery. Though she's raced nine Ironman triathlons since, she doesn't recommend surgery as a first course of action: "Mine were extreme IT band injuries."

Don't feel her pain: Relief and prevention come through a two-pronged approach of strengthening and soft tissue massage, said ESPN injury analyst Stephania Bell, PT. "Strengthening the outer glutes is key," she said. When the outer glutes are weak, your pelvis drops from side to side during forward motion. That sashay may be sexy, but it's putting a lot of tension on the IT band, said Bell. Strong glutes help control lateral stability. Foam roller massage helps stretch, mobilize and loosen the band so it moves freely. "It's miserably uncomfortable, but very effective," said Bell. Her go-to moves:

Hip Hike: Stand sideways on a step with your right foot on the step and the left hanging off the side. Keeping both hips squared and your right leg straight, lift your left hip straight upward. Pause and then lower it, dropping the foot toward the floor. Do 2 or 3 sets of 12 to 15 reps on each side, 2 or 3 days a week.

IT Massage: Lying on your side, rest the outside of your thigh on top of a foam roller and roll your IT band along it from your knee to your hip. Do it twice a day for several minutes at a time.

Other tips for babying the band:
Avoid activities that put the band under undue tension, such as running on banked surfaces, wearing worn-out shoes, cycling with toes turned in and ramping up mileage too quickly. Most important, if you feel pain on the outside of your knee, stop. Pushing through it can make it chronic. Ice the injury three times a day for the first few days. You can do any cross-training that doesn't cause pain. Otherwise, rest and rehab it until you don't feel pain when you bend the leg. Then resume activity gradually.

On deck: Tennis elbow