Iliotibial Band (ITB) Syndrome & Physio
The Iliotibial band (ITB) is commonly blamed for causing pain on the outer aspect of the knee. It is an overuse injury known as “runner’s knee” or IT Band Friction Syndrome, frequently associated with distance runners and cyclists, though it also occurs in weightlifters, skiers, soccer players, hockey players, triathletes, and competitive rowers (Fairclough et al, 2006 & Strauss et al, 2011). The cause of pain is a subject of debate. Theories include friction of the IT band along the outer aspect of the thigh bone during repetitive flexion and extension activities; compression of the fatty and connective tissue deep to the ITB; or inflammation of the bursa underlying the ITB.
The ITB is a dense fibrous connective tissue that runs alongside the outside of the thigh, originating from the fibers of the gluteus muscle, and tensor fascia latae (TFL) muscle, and attaches to just below the knee.
Its primary functions are:
To provide stability for the outer hip and knee and
l
imit inward rotation of the knee.
The ITB has been found to have the capacity to store 15 to 20 times more elastic energy per body mass.
Characteristics of Runner's Knee
Runner’s Knee is a collection of symptoms surrounding knee pain in runners, either during or after running. Iliotibial Band Syndrome (ITBS) is the most common injury of the outer aspect of the knee within the sports of running and cycling. It is a non-traumatic overuse injury caused by repeated flexion and extension of the knee that causes irritation of the structures around the knee.
Clients typically present with tenderness or pain over the outer aspect of the knee and report a sharp, burning pain when pressure is applied to the tender spot. The pain can be particularly acute when the knee is bent at 30°. This happens because the ITB is compressed against the bony prominences (epicondyle) of the knee as a result of tibial internal rotation during knee flexion (Fairclough et al, 2006). This is described as the “impingement zone” when the knee is flexed at 30degrees during foot strike and early stance phase of running. Tension in the ITB is generated to help with deceleration of the leg.
IT Band Syndrome is viewed by many as a failed healing response that results from repetitive friction of the fibrous band rolling over the bony prominence during knee movements. Physios can diagnose and treat this condition. Due to the complex anatomy of the ITB you will need a detailed assessment to identify the root cause of your injury. This may include walking and running gait analysis.
Here are a few treatment techniques your physio may use for Runner’s Knee/IT Band Syndrome:
Education and advice around modifying activities to minimise injury provocation, which in turn will encourage healing.
Load management. This may mean reducing your running distance or intensity initially, and progressively increasing your load by adding in distance and incline into your programme.
Soft tissue massage or mobilisation.
Providing a home management program. This may include self trigger-point and muscular release, stretching and self-mobilisation of certain structures.
Taping or strapping if required.
Strength training. This should be created specifically to target any weak muscles identified during the assessment process. This can be progressed to a gym based program in time.
Deceleration training. The tension in the IT Band causing the issue occurs when the leg is decelerating during running, so this should be incorporated into the client’s training.
Strategies to avoid re-injury. Your physio should provide you with tools to help prevent this injury from reoccurring.
Referral to other healthcare professionals if required. For example, podiatry for orthotics.
Jenny Chen, Physiotherapist
M.R.S Physiotherapy