Iliotibial Band Syndrome (ITBS) is a common injury that plagues runners, cyclists or weight-lifters (especially during squats). ITB syndrome is one of the main causes of knee pain in runners. The IT band is a thick band of fibrous tissue that runs along the outside (lateral) part of the knee, extending from outside the pelvis, over the hip and ending just below the knee. The band is extremely important in stabilizing the knee during running. During activity it moves from behind the femur (thigh bone) to the front of the femur. The continuous friction (rubbing) of the band over the lateral femoral epicondyle, paired with repeated extension and flexion of the knee could cause the area to become inflamed. The pain is typically felt on the side of the knee and not in the hip of the thigh. ITB syndrome is believed to be an overuse injury. Some cases of IT band pain can be so debilitating that a runner will have to completely stop for several weeks at a time or more.
Symptoms of ITBS include:
a stinging feeling above the knee
swelling where the IT band crosses over the femur
snapping or popping when the knee is bent
pain at the side of the knee
In the past it was thought that the cause of pain was an overly tight IT band that needed to be foam-rolled or stretched. Shoes were often blamed, and orthotics prescribed. We now know that the IT band is affixed all the way down the leg, and stretching, massage or other manual therapies cannot release it.
Diagnosis and Treatment of ITBS
In addition to a clinical examination, diagnostic ultrasound is useful in identifying ITBS, and in ruling out other potential causes of pain like bursitis or tendinopathy. Computerized gait analysis reveals mechanical deficiencies throughout the running gait cycle that can lead to ITBS.
The primary underlying cause of ITBS in runners is deficiency in one or more aspects of gait mechanics: Stride length, step rate and gait crossover.
Common mechanical faults during running include:
Extended ground contact: The foot remains in contact with the ground for too long, increasing knee flexion and adding to nerve irritation
Hip drop: During the stance phase of running, the non-stance hip drops, increasing load on the stance leg and causing it to rotate inward
Cross-over gait: During running, the forward foot crosses over the rear foot, angling the legs inwards
ITBS may also be caused by other types of faulty movement mechanics, overtraining, postural problems and muscle imbalances.
The first line of treatment for ITBS is rest from physical activity and pain management, including ice and elevation to reduce inflammation.
Physical therapy for ITBS is likely to be multi-modal, and may include:
Running gait retraining
CAREN (Computerized Assisted Rehabilitation Environment) training
Stretching and strengthening exercises to promote balanced muscle tension
Postural correction exercises
Sport-specific technique modification and retraining
Recovering from ITBS is a process of training and re-educating your body in coordinated muscle recruitment and improved mechanical efficiency during physical activity.
IT Band Syndrome Treatment
Iliotibial Band Syndrome (ITBS) is a common injury that plagues runners, cyclists or weight-lifters (especially during squats). ITB syndrome is one of the main causes of knee pain in runners. The IT band is a thick band of fibrous tissue that runs along the outside (lateral) part of the knee, extending from outside the pelvis, over the hip and ending just below the knee. The band is extremely important in stabilizing the knee during running. During activity it moves from behind the femur (thigh bone) to the front of the femur. The continuous friction (rubbing) of the band over the lateral femoral epicondyle, paired with repeated extension and flexion of the knee could cause the area to become inflamed. The pain is typically felt on the side of the knee and not in the hip of the thigh. ITB syndrome is believed to be an overuse injury. Some cases of IT band pain can be so debilitating that a runner will have to completely stop for several weeks at a time or more.
ITBS symptoms could be:
a stinging feeling above the knee
swelling of the tissue where the band goes over the femur
a snapping or popping sensation when the knee is bent
however Iliotibial band pain is a “side of the knee pain”
The stinging feeling that is felt above the knee joint on the outside of the knee. At times the pain may strengthen over time and may not be felt in the beginning or during activity. In some instances the IT band pain may be felt above or below the knee, where it attaches to the tibia.
Some activities to avoid when suffering from IT band syndrome:
Running
Climbing stairs
Biking
Squats
Soccer
Skiing
Dancing
Tennis
Martial Arts
Gold
Basketball
Skating
Gymnastics
Lacrosse
While the causes of ITBS may vary on a person by person basis and at times more than one cause may be a factor in falling victim to Iliotibial band pain. Some causes may be a combination of biomechanical tissue, weekly mileage, training methods, personal muscle imbalance etc… Keep in mind that you do not to have a knee specific knee injury to have ITB syndrome.
Intrinsic Factors may be:
Leg length difference
Limited ankle rang e of motion
Weakness of the knee muscles
Poor control of the knee muscles
Weakness in hip abductors (most common in long distance runners)
Flat feet or high arches
Myofascial limitations in the hip and thigh muscles
Bowed legs
Knock-Knees
Extrinsic Factors may be:
Training mistakes
Excessive mileage
Improper or old running shoes
Not warming up or cooling down correctly
Sudden increase in training intensity
Sudden increase in miles running
To much running on a hill
Tissue injury complex must be identified. A diagnostic ultrasound may be the most useful modality to differentiate between tendinopathy or bursitis at the site of injury.
By addressing these two factors it is important to minimize stress of the ITB and in turn it will reduce the risk of injury. Tissue injury complex must be identified. A diagnostic ultrasound may be the most useful modality to differentiate between tendinopathy or bursitis at the site of injury. When IT band syndrome is acute therapy options could be rest, ice, and elevation. to minimize and reduce the swelling and pain combined with stretching. ITBS treatment could be a combination of several ITB physical therapy modalities that will result in a wider range of motion and improved comfort and reduced pain. Iliotibial band treatment should include removal of adhesions with myofascial release techniques such as ART, graston and others, custom foot orthotics which would control the medial rotation of the foot and in turn reduce the rotation of the knee and leg. Too much rotation of the knee creates friction of the band against the other part of the knee. A compression wrap can also be utilized to help stabilize the knee where the tendon contacts to the patella. Multiplanar muscle stretching and hip abductor strengthening. Gait and running analysis is very helpful in diagnosis and planning of rehabilitation as well as running technique retraining.
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