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iliotibial band syndrome

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Illotibial Band (ITB) Syndrome

Knee pain is one of the most common injuries in runners. In recent polls, from 38% to 43% of all runners questioned related they had knee pain caused by running which had led to a decrease or stop in their running. Outside (lateral) knee pain is commonly caused by the Iliotibial band syndrome. It can occur at two places on the outside of the knee, especially in males, and at the outside of the hip, especially in females.

The structure involved is a small muscle at the hip, the tensor fascia lata which attaches from the pelvic bone just above the hip to the leg bone just below the knee with a tendon called the ilio (hip) tibial (leg) band. Its function is to stabilize the outside of the hip and knee as the foot makes contact with the ground. At this time a tremendous amount of pressure is shooting up the leg toward the knee, hip and back. This pressure is increased the faster you run, the longer your stride, the steeper the downhill, the more outside heel wear present, and the less shock absorbing qualities your shoes have. An unstable knee or hip would lead to major injuries if the Iliotibial band did not normally tighten and stabilize these joints.

Another cause of this problem is from unstable feet. If there is excessive inward rotation of the lower leg bone on the thigh bone, the band is suddenly rotated inward and can be irritated at the knee or hip as it rubs against bony projections. It is often found in runners with bowed legs and those who run on the outside of the foot (supinated).

Treatment

Treatment of this syndrome first involves discovering its cause or causes, then decreasing the foot instability with orthotic devices and/or decreasing the excessive shock by changing shoe gear, training patterns, etc.

It is difficult to change running habits, but be careful not to settle into your hips causing side-to-side stress. Coaches would say, “Rise up – run, don’t jog.” Like any tendon or muscle, this structure can become overused and inflamed with any condition increasing the pressure, i.e., excessive downhill running. Avoid running on tilted surfaces, contacting one foot higher or lower than the other.

Physical therapy should be used to decrease the inflammation in the area. Ice massage, ultrasound, friction massage, stretching and strengthening exercises, oral medication, etc., can be used.

Healing of this problem, once treatment has begun, is usually two times longer than the length of time the injury has been present. Emphasize strengthening more than stretching. Do some mixed motion, low-impact sports (soccer, low-impact aerobics, etc.) while you are returning to your regular mileage.

The “ITB Syndrome” usually has tightness developing along the outside of the knee or hip during a run long before soreness or pain develops. If you notice this tightness developing, stop running at this point and stretch out the Iliotibial band. Lean your injured side hip toward the side of pain by tilting your trunk and upper body the other way. You will feel the stretch in the upper thigh/hip area, but it is stretching the entire band down to the knee. We recommend a ten-minute ice massage before running, followed by stretching, followed by light running for five minutes in an easy warm-up before hard running. Stop and stretch if you feel the band tighten and try to run again. If you are still having pain while running, try altering your style by minimizing impact, land more forward on the foot, and push off through the toes, which takes the stress from the knee to the calf muscles. Do not try to run through pain or it will get worse. Try breaking your runs into two workouts of half the total distance each. You can usually maintain high mileage with this injury. Even if orthotics are used, aggressive treatment of the acute or chronic localized inflammation should be done.