Iliotibial band syndrome (ITBS) is a common athletic injury that affects runners, cyclists and weightlifters. It is a common cause of knee pain in runners. The iliotibial band is a thick, fibrous band of fascia (connective tissue) that runs down the outside of the upper leg, from just above the hip to just below the knee.
The IT band plays an important role in knee stability during running, moving from behind the knee to the front of the femur with each stride. Repetitive knee movement coupled with continual rubbing of the IT band over the lateral condyle of the femur can cause the band to become inflamed, resulting in pain at the side of the knee, the primary symptom of ITBS.
About Dr. Lev Kalika, Clinical Director and DC, RMSK
Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Dr. Kalika is the author of multiple medical publications and research, and an international expert in the field of gait and motion analysis, 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.
Using research grade technology for motion analysis and movement retraining, Dr.Kalika has perfected his personal approach to the treatment of IT Band syndrome. NYDNRehab features some of the most technologically advanced rehabilitation equipment in the world, rarely found in a private clinic.
Why Treatment at NYDNRehab is Better than Conventional ITBS Physical Therapy
Our experience in combining innovative treatment methods with advanced technologies makes NYDNRehab the number one choice for physical therapy, chiropractic care and rehabilitation in NYC. We use FDA approved methodologies to successfully treat a broad range of conditions. Our patients include elite athletes and ballet dancers who come to us for rehab and performance enhancement.
We take a one-on-one approach to patient care. We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our treatment plans to the individual, and never use cookie cutter approaches.
We are the top rated physical therapy clinic for lower extremity conditions in NYC. NYDNRehab accepts most health insurance plans, and we are happy to set up payment plans for our patients.
Symptoms and Causes of ITBS
Symptoms
Knee pain while running, dancing or cycling
Sharp pain at the outside of the knee
Clicking or popping at the knee joint
Stiffness and reduced range of motion
Increased pain at 30º flexion
Causes
Overuse from sports, dance or exercise
Incorrect training mechanics
Muscle weakness or lack of flexibility
Sudden increase in training load or volume
Inadequate pre-training warmup
Accurate ITBS Diagnosis Means Successful Treatment
Our specialists use high resolution diagnostic ultrasonography for dynamic imaging of the IT band and its motion across the lateral femoral condyle. With the help of sonoelastography, a new feature only available with ultrasound imaging, tissue elasticity can be measured and progress can be tracked and monitored.
The use of 3D motion and gait analysis as a diagnostic tool is another unique feature of our clinic. It is extremely effective for both diagnosis and real time feedback retraining.
Please explore more advanced diagnostic option unavailable anywhere else:
In addition to traditional soft tissue treatment of rest, ice, compression and elevation (RICE), IT band physical therapy is the best way to resolve symptoms and return to full functional performance capacity. Our treatment approach is multifaceted and involves a unique combination of technologies and therapies that cannot be found elsewhere.
At NYDNRehab, we work with runners, dancers and athletes on a daily basis to relieve pain, rehabilitate injuries and enhance performance. Our team of sports medicine specialists understands the importance of flawless pain-free performance.
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.
Our ITBS rehab toolbox includes:
High-resolution diagnostic ultrasound, to accurately diagnose, treat and monitor 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 underlying cause of ITBS, to restore optimal function and performance.
IT Band Regenerative Therapies with Ultrasound Guidance
Regenerative therapies are used to stimulate cellular neogenesis in damaged tissues. At NYDNRehab, we use the most cutting-edge technologies available to promote new cell growth, to help the body heal itself. Our regenerative treatment options include:
Focudsed, Defocused and Radial Shockwave
Electromagnetic Transduction Therapy (EMTT). This promising new technology uses pulsed electromagnetic fields (PEMF) to reduce inflammation and stimulate new cell growth. EMTT is often used in conjunction with ESWT.
Extracorporeal Shock Wave Therapy (ESWT). This non-invasive therapy uses supersonic waves to stimulate the body’s cells, especially in tissues like tendons and connective tissue that have low vascularity. The waves are able to increase the transport of oxygen and nutrients to the damaged cells, to trigger repair and regrowth.
When combined, ESWT and EMTT work together to revitalize damaged cells and instigate healing, for immediate therapeutic results, including significant pain relief and regenerative effects on muscle and connective tissues.
Ultrasound Guided Needling Procedures. Regenerative injection therapies like platelet rich plasma (PRP), hyaluronic acid and Prolotherapy use substances naturally found in the human body to stimulate healing. Ultrasound guidance helps to ensure that the injections accurately reach the targeted tissue.
EMTT
Get Personalized IT Band Physical Therapy, Designed Just for You
At NYDNRehab, we take a one-on-one approach to patient care. We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our treatment plans to the individual, and never use cookie cutter approaches.
Our experience using innovative treatment methods and advanced technologies makes NYDNRehab the number one choice for IT band physical therapy and rehabilitation in NYC.
Get Pain-Free ITBS Treatment That Really Works
Conventional medicine treats ITBS at 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 that our athletes, dancers and runners with ITBS are accurately diagnosed and fully rehabilitated.
We help our patients get long-term relief by accurately diagnosing the underlying causes of ITBS, retraining motor patterns and restoring neuro-motor pathways. Our treatment approach goes beyond pain management, to actually regenerating damaged tissues and promoting healing. We are the top rated physical therapy clinic for ITBS in NYC.
Our Rewards
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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