Specializing in Spine, Sports & Physical Medicine

Iliotibial Band Syndrome

Iliotibial Band Syndrome (Runners Knee)

Iliotibial band (ITB) syndrome is often referred to by other names, most commonly, runners knee and Iliotibial band friction syndrome. All of these refer to the same syndrome. The Iliotibial band is a thick ligamentous band that attaches at the hip
to both the iliac crest (hip bone) and the tensor fascia latae muscle. It then courses down the outside of the thigh (femur) and inserts into the outside of the tibia (leg bone). The ITB is not attached to the bone as it passes between the femur and the tibia. This allows the ITB to move forward and backward with knee flexion and extension. At a knee angle of approximately 20-30 degrees the iliotibial band flicks across the lateral epicondyle of the femur. When the knee is being straightened it passes in front of the epicondyle and when it is bent, it goes back behind. Iliotibial band syndrome is common in runners because 20-30 degrees of knee flexion is the approximate angle of the knee when the foot strikes the ground. This passing over the bone over and over can cause in certain prone individuals undo friction and therefore pain.The ITB is a primary stabilizer for the knee. It helps control inward motion of the hip and knee during the foot strike phase of walking or running. So, as you are walking, running or even cycling the ITB helps slow down and controls the knee from rolling inwards. Consider this, the average runner strikes the ground 90 times per minute with each leg. In a marathon it can be over 20,000 times. With those kind of repetitions, it is no wonder that some people can develop a painful iliotibial band.

Signs and Symptoms of Iliotibial Band Syndrome:

  • Pain on the outside of the knee (at or around the lateral condyle of the femur)
  • Tightness along the iliotibial band
  • Pain normally aggravated by running, particularly downhill
  • Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee
  • Weakness in hip abduction
  • Tender trigger points in the gluteal area may also be present

Factors contributing to development of ITB syndrome

  • A naturally tight or wide IT band
  • Weak hip muscles such as gluteus medius
  • Trigger points within the IT band and gluteal muscles
  • Overpronation
  • Overuse
  • Excessive hill running
  • Running on a cambered surface
  • Leg length difference
  • In cycling, having the feet “toed-in” to an excessive angle

Self Help Treatments

  • Rest. Avoid painful activities, e.g. downhill running, low cadence big gear cycling
  • Apply cold therapy or ice to reduce any inflammation
  • Stretch the Iliotibial band after training
  • Self massage techniques and use of a foam roller

If you think you have ITB syndrome and you are not improving you should consult with a healthcare provider that is familiar with the diagnosis and treatment of this condition. Some of the treatments prescribed include:

  • Soft tissue or deep friction massage by a licensed physical therapist
  • Anti-inflammatory medication such as NSAID’s e.g. Ibuprofen
  • Use of Myofascial release techniques
  • Rehabilitation program to include stretches and exercises to strengthen the hip abductors
  • A cortisone injection into the irritated area may be effective in an acute situation
  • Corrective orthotics

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