The iliotibial band is the thickening of the tensor fascia lata muscle that starts on the outside of the hip and ends on the outside of the knee. Iliotibial band syndrome (ITBFS) is a repetitive stress injury that occurs when the iliotibial band glides over the lateral femoral condyle on the outside part of the knee. This is most common at about a 30° bend in the knee. Research is now showing that there may be some compression of the IT band at the knee that can contribute to the pain as well.
ITBFS is a common injury for long distance runners (20-40 miles/week). Running on various terrains such as hills, graded slopes, and cambered roads can increase the risk of developing this injury. Studies have found that long distance runners with ITBFS have weaker hip abductor and gluteus muscles on the involved leg compared to the uninvolved leg. The hip abductor muscles are located on the outside part of the hip and help prevent the leg from moving towards the center of the body. Fatigued runners are more prone to having their hip adduct (move towards the center) and internally rotate (leg turns inwards) which causes more friction and compression on the iliotibial band and therefore the symptoms get worse. Although ITBFS is more common in runners, it is not exclusive to runners. Cyclists, weight lifters, downhill skiers, and participants in jumping sports are also commonly affected by this injury.
In ITBFS pain, patients often report an ache on the outside aspect of the knee. There is rarely a history of trauma. The pain often comes on around the same time/distance during the activity. There may be some swelling noted and usually the pain increases going up and down stairs. Walking on level surfaces generally doesn’t reproduce the pain. Imaging is not required for a diagnosis, however, ultrasound and MRI can confirm thickening of the IT band.
Although the pain is felt in the knee, treatment often focuses on the hip and foot. Non-steroidal anti-inflammatories (NSAID’s), ice, and electrotherapy may provide some relief. Soft tissue treatment, IMS, and foam rolling around the hip can also be used to reduce muscle tension. Stretching of the tensor fascia lata and gluteus muscles can be helpful. For long-term recovery, strengthening of the hip muscles is important. This helps address underlying weakness and reduces the chance of fatigue. Activity modification (usually decreasing mileage) and properly fitting shoes are also important. Surgery is reserved for only those cases that conservative treatment hasn’t worked.
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