Physical Mechanics Relative to Iliotibial Band Syndrome for Runners

Physical Mechanics Relative to Iliotibial Band Syndrome for Runners

Running is one of the most popular forms of fitness activity practiced by the global exercising population today. It is also a major part of athletic training for most professional, collegiate and amateur sports teams. Although running regularly is beneficial in many ways to the human musculoskeletal system, it also can result in bodily injuries due to excess stress and overuse of muscles, tendons, joints and connective tissues requiring sports injury treatment. Research studies have revealed that rates of injuries incurred by a runner that are due to overuse during one year vary from approximately 55 percent to 85 percent. The level of injury rates attributed to overuse by cross country collegiate runners was reported in a recent study as equaling about 75 percent.1 Knee pain-causing injuries actually are the most frequently incurred variety of injury among running athletes, accounting for from one-quarter to nearly one-half of all running injuries reported each year. ITBS, or ITB syndrome, is the most frequent cause of lateral knee pain and one of the most common types of overuse injury suffered by joggers and racers today.

Structural Function of the Iliotibial Band

The iliotibial band has multiple important functions. Due to its placement, it stabilizes lateral movement of the knee and hip and also reduces the extent of internal knee rotation and flexibility of the hips. Since greater hip movement and increased angles of rotation for the knees during alternating extension and bending can elevate degrees of tensile as well as torsional stress of the iliotibial band, this major stabilizing band can be injured easily during a lengthy jogging session or race. IT band syndrome pain may also be heightened by increased pressure on the fat tissue and nerves separating the iliotibial band from the lateral femoral epicondyle, or tubular bone formation. The iliotibial band repeatedly compresses this bone during knee bending and extension.2 Due to structural differences of the male and female bodies, causes of ITBS differ for men and women.

Kinetic Aspects of ITB Syndrome in Women Joggers

Women runners with ITB syndrome pain have more pronounced and flexible hip motion and angles of internal knee rotation at baseline than do other female athletes. Many running enthusiasts who suffer injury from overuse have previously injured the same part of the anatomy, and the iliotibial band is one of the most often injured bodily areas for female running athletes. A study conducted in 2015 revealed that women who currently suffer from ITB syndrome often show more pronounced external hip rotation angles, specifically, in late stance, than do healthy female runners.3 It is interesting that internal rotation angles of the knee have been proven to be very much alike in runners with current ITBS, previous iliotibial band syndrome patients and healthy athletes. Research has also revealed that the existing injury level of a female runner does have an effect on her running form. For instance, women previously afflicted with this syndrome may exhibit reduced hip motion angle while running as a natural, precautionary reflex. If this overuse injury and knee pain is currently healing, less flexible hip movement by the runner may help alleviate pain during exercise and sports injury treatment.

IT Band Syndrome Kinematics in Men Joggers

Although there have been numerous studies concerning the biomechanical aspects of ITB syndrome symptoms in female runners, only a few research investigations have focused on men. In fact, there are no such current reports available concerning male running enthusiasts. Research has revealed that men currently afflicted with ITBS show larger peak internal rotation of the hips and more extensive knee bending and flexing in early stance than healthy men. It has been discovered that pronounced internal rotation of the hip along with knee bending and flexing may actually result in elongation of the iliotibial band, which elevates degrees of stress and strain on this active band. Differences have also been noted in internal rotation of the ankles in men runners who are currently under treatment for ITB syndrome and those not afflicted. However, this may indicate a defensive reaction by which male runners who have this syndrome can alleviate the strong discomfort of excess stress on the iliotibial band as well as knee pain. The general consensus among researchers is that in men athletes who run, the occurrence of ITB syndrome development may have some connection with both distal and proximal kinematic elements and explanations.

Hip Strength Relative to ITB Syndrome in Men and Women

Women runners currently plagued by ITB syndrome have been reported as flexing the trunk in the direction of the stance leg within the frontal plane with more frequency than women joggers who were previous IT band syndrome patients or healthy athletes. This may very well be a compensation movement for the purpose of lightening stressful motion of the hips. It is now recommended that ITB syndrome treatment focus on trunk movement along with hip flexibility capacity, continuing after this syndrome pain is alleviated. Lack of external hip rotational power may cause reduced abilities of the runner to control internal hip movement, which may elevate levels of iliotibial band stress and strain and require sports injury treatment. Any male runner with iliotibial band syndrome who shows higher degrees of internal hip rotational action in comparison with control subjects also displays lower levels of isometric external hip rotation capability than do healthy male running athletes. Resulting data such as this strongly suggests that male and female running enthusiasts should be studied in separate groups for strength variables linked to ITB syndrome. For both men and women with this syndrome, multi-joint exercises involving the muscles of the lower extremities may help significantly in eliminating any additional deficiencies in strength variables relative to movement of extremities and connected joints.

Training Runners for Hip Strength and Gait Correction

Based on study results, many running coaches, sports trainers and some sports medicine experts recommend some degrees of training for increased hip strength and gait correction for any runner with ITB syndrome and knee pain. However, the few research studies conducted for this aspect of IT band syndrome resulted in the conclusion that improvements in running form are not dependent solely on increasing the strength of the lower extremities. When running athletes were trained to keep their knees directed straight ahead and to land with their feet further apart while running, the corrected alignment of lower extremities and improved gait resulted in less stress and strain on knees and less knee pain. It also lessened stress on hips and on the iliotibial band for greatly reduced pain.4

However, since research, to date, does not identify specific gait training or hip and knee strengthening techniques for use in sports injury treatment of patients diagnosed with this syndrome or for alleviating knee pain, biomechanical abilities of each individual patient should be carefully assessed. This will enable sports medicine practitioners and rehabilitation therapists to structure each patient treatment and rehab plan as a customized fit for every runner or athlete seeking relief from ITB syndrome pain and discomfort.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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