What is Iliotibial Band Syndrome (ITBS)?
By Laurence Schubert APAM
Iliotibial band Syndrome (ITBS) is a common injury that results in pain at the lateral aspect of the knee. The Iliotibial band (ITB) is a non-contractile band that runs from the outer hip to the lateral knee. ITBS is an overuse condition and is primarily caused by repetitive knee flexion and extension; therefore it is seen most frequently in runners or cyclists. During knee flexion and extension, the ITB glides over the lateral aspect of the knee. However, this repetitive motion along with other factors can cause excessive friction, leading to the pain experienced by those with ITBS.
What Causes Iliotibial Band Syndrome?
- Overuse/poor load management - This is the most important factor for most cases of ITBS and overuse injuries. For example, changes in training volume need to be incremental and measured. Determining your training load must take into consideration factors such as age, current physical condition, previous injuries and type of training.
- Poor biomechanics - This includes a host of biomechanical deficiencies, either occurring naturally or due to previous injuries. The most common finding for people with ITBS is weakness and poor control of hip abductors (glutes). Poor control or weakness of the hip abductors will lead to increased internal rotation of the hip and knee valgus. This changes the length tension relationship of the ITB and increases the tensile force applied to the attachment of the ITB. Other important factors that affect ITBS include footwear, RUNNING TECHNIQUE and gender (more common in females due to greater hip angle).
What are the Symptoms of Iliotibial Band Syndrome?
The subjective information from the patient will largely determine if they are suffering from ITBS. They will likely be experiencing pain on the lateral aspect of knee, that can feel like a burning sensation that moves up or down. Pain is particularly noticeable during physical activity such as running, cycling or any activity that involves lots of knee flexion/extension (bending/straightening). When the condition is more severe, the patient will notice pain upon heel strike during walking as well pain following completion of exercise. In some cases patients will experience a snapping or popping sound at the knee, which is where the ITB glides over the knee. This can also occur in non-injured patients.
There are many different injuries that present similarly to ITBS; therefore, it is critical your physiotherapist or health professional conducts a thorough assessment. Differential diagnosis for ITBS include: Patello-femoral pain syndrome (PSPS), strained LCL (lateral collateral ligament), biceps femoris tendinopathy, osteo-arthritis, lateral meniscus injury, popliteal tendinopathy, trochanteric bursitis, stress fractures, osteochondritis dissecans.
How do you treat Iliotibial Band Syndrome?
In almost all cases of ITBS, you will make a full recovery with conservative treatment. Only in extremely rare cases will surgery need to be considered.
Initially, a period of modified rest is needed to prevent further aggravation of your symptoms. This will include a review of your training program and likely modifying your activity to exercises that won't aggravate the pain. At PhysioLife we rarely will prescribe complete rest; instead we will discuss other activities more suitable for your injury.
Through a thorough assessment your physio will identify the most important factors contributing to your condition. Your physio will use a combination of massage, manual therapy and additional modalities such as dry needling or shockwave therapy. The treatment will focus on lengthening and reducing the tensile force of the ITB. Exercise rehabilitation makes up a large portion of the recovery; this is essential to ensure the condition improves and does not return. The ITB and glutes are the most common areas focused on during the exercise rehab. Typically this will include stretches and strengthening exercises that improve hip abduction control. You may require retraining of running, jumping or alternate movement tasks.
To get you started:
- Foam rolling through glutes and ITB (lateral aspect of thigh) â€“ complete 2 minutes x3 per day.
- Glute stretch - whilst sitting, cross affected
leg over the other knee and lean forward until a gentle pull is felt in the
outside of the hip. Hold for 15 second and complete 3 times.