Runner’s Knee: Iliotibial Band Syndrome
What is Iliotibial Band Syndrome?
Iliotibial band syndrome is a condition that commonly presents in runners and typically causes pain at the outer aspect of the knee where the iliotibial band (ITB) crosses the knee joint.
Iliotibial band syndrome describes a condition where the iliotibial band rubs against a bony prominence at the outer aspect of the knee and typically causes inflammation and damage to local tissue.
What is the Iliotibial Band (ITB)?
The iliotibial band (ITB) is a long band of connective tissue than runs down the outer aspect of the thigh. It originates from two muscles on the outer aspect of the hip (the tensor fascia latae (TFL) and gluteus maximus – figure 1) and runs down past the knee to attach into the lower leg bone (tibia). As the ITB crosses the knee, it overlies a bony prominence known as the femoral epicondyle. As the knee bends and straightens the ITB flicks over this bony prominence which places friction on the ITB and local soft tissue. If this friction becomes excessive or too repetitive (such as during excessive running) the ITB or local tissue can become damaged or inflamed resulting in pain. When this occurs the condition is known as Iliotibial band syndrome.
Signs and symptoms of Iliotibial band syndrome
Patients with iliotibial band syndrome usually experience some of the following symptoms:
- Pain on the outer aspect of the knee
- Aggravated by repetitive bending and straightening of the knee
- Aggravated by downhill running
- Pain may be worse in the morning, or after cooling down post-activity
- pain on firm touch where the ITB crosses the outer aspect of the knee
- The ITB may ‘click’ with bending and straightening of the knee
Contributing factors in the development of Iliotibial band syndrome
There are several factors which can predispose patients to developing Iliotibial band syndrome. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- excessively tight ITB
- muscle tightness (particularly TFL, gluteus maximus, or vastus lateralis)
- excessive or inappropriate training or activity
- abnormal biomechanics
- excessive pronation (i.e. flat feet)
- poor pelvic or core stability
- muscle strength imbalances
- muscle weakness (especially the VMO and gluteal muscles)
- tightness in specific joints (hip, knee or ankle)
- inappropriate footwear or surfaces
- poor running technique
Treatment for Iliotibial band syndrome
Most cases of Iliotibial band syndrome settle well with appropriate physiotherapy. This requires careful assessment by the physiotherapist to determine which factors have contributed to the development of the condition, with subsequent correction of these factors.
Some of the the key components of early management are:
- Ice and possible anti-inflammatory use (as advised by your health care practitioner)
- Adequate rest to allow symptoms to settle
- Pain free stretching and flexibility work
- Assessment by your Physiotherapist
Physiotherapy for Iliotibial band syndrome
Physiotherapy treatment for Iliotibial band syndrome is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
- soft tissue massage (particularly to the ITB)
- dry needling
- ice or heat treatment
- exercises to improve flexibility, strength and balance
- activity modification advice
- biomechanical correction
- anti-inflammatory advice
- clinical Pilates and core stability exercises
- footwear advice