IT Band Syndrome
(ITBS)

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.