Iliotibial band syndrome (ITBS) is a common athletic injury that affects runners, cyclists and weightlifters, and is a common cause of knee pain in runners. The thick, fibrous IT band runs down the side of the leg, beginning outside the pelvis, and traveling over the hip to end just below the knee.
The IT band plays an important role in knee stability during running, moving from behind to the front of the femur with each stride. Continual rubbing of the IT band over the lateral condyle of the femur coupled with repetitive knee movement can cause the band to become inflamed, resulting in pain at the side of the knee.
IT Band Symptoms
Stinging sensation above the knee
Inflammation where the IT band crosses the femur
Snapping or popping in the knee
Pain at the side of the knee
In the past ITBS was thought to be caused by tightness or insufficiently supportive footwear, and stretching and orthotic shoe inserts were commonly prescribed solutions. However, it is now known that the IT band is firmly affixed down the side of the leg, and cannot be released by stretching or manual therapies.
Mechanism
There is a small fat pad located between the illiotibial band and the lateral femoral condyle. Compression and grinding on this fat pad produces symptoms of pain. Compression is almost always caused by poor biomechanics and inefficient running style.
Causes of ITBS
Because of the location and length of the IT band, many factors can contribute to ITBS.
Common causes include:
Sudden increase in running milage or training intensity
Limited ankle range of motion
Weak or imbalanced muscles surrounding the knee
Faulty gait mechanics
Too-flat or too-high foot arches
Tight hip abductors
Repetitive exercise overuse
Running on hills
Postural deficiencies
Anatomical predisposition
Diagnosis of ITBS
The sports medicine specialists at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography. Diagnostic Ultrasound not only enables the doctor to identify the structural causes of knee pain, but it allows your clinician to view the knee region in real time, with the knee in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.
In conjunction with clinical exam, diagnostic ultrasound can provide an accurate diagnosis of ITBS, while ruling out other causes of pain such as bursitis or tendinopathy.
Computerized gait analysis can provide useful information about faulty gait mechanics that lead to ITBS, which is the primary cause of the condition in runners.
Please explore more advanced diagnostic option unavailable anywhere else:
In addition to classic soft tissue treatment of rest, ice, compression and elevation, physical therapy is the best way to resolve ITBS and restore healthy function.
IT Band Specialist NYC
At NYDNRehab, we work with runners, dancers and athletes on a daily basis for pain, injury rehab and performance enhancement. Our team of sports medicine specialists understands the importance of flawless pain-free performance.
We know that simply strengthening the muscles and healing injured tissues is not enough. For effective treatment and safe return to sport, it is crucial to retrain the brain and neuromuscular system as well.
In the case of ITBS, conventional medicine treats the locus of pain without considering the interdependent structures that underlie its mechanisms. At NYDNRehab, we use the most advanced and innovative technologies to ensure our athletes, dancers and runners with ITBS are accurately diagnosed and fully rehabilitated.
Our ITBS rehab toolbox includes:
High-resolution diagnostic ultrasound, for accurate diagnosis, treatment and monitoring of progress
C.A.R.E.N, our computer assisted rehab environment, for restoring stability and balance and providing real-time feedback for neuromuscular retraining
Kineo Intelligent Load system, for accurate and effective loading of the lower body, with real-time feedback for brain retraining
DDRobotech system for sensorimotor feedback during strength training, to speed recovery and enhance neuromuscular and neurocognitive performance
Our advanced technological systems take the guesswork out of rehab, providing quantitative data and accurate analysis that ensures our athletes can return to sport as quickly and safely as possible.
A good rehabilitation program for ITBS will re-educate your body in coordinated muscle recruitment and improved movement mechanics. At NYDNRehab, we go beyond treating your pain to correcting the source ITBS, to restore optimal function and performance.
Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.
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.
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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