Definition of Iliotibial Band Syndrome:
Iliotibial Band Syndrome (ITBS) is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.
Symptoms of Iliotibial Band Syndrome:
ITBS symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.
ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight—each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known, This may also happen when a child or teens hip grows faster than the band, and it creates tightness over the hip and knee, therefore creating a popping and snapping over the hip or knee.
Sports activities to avoid while symptomatic
- Stair climbing or mountaineering
- Deadlifts or squats
- Court sports, such as tennis, basketball, or similar
- Martial arts, such as karate (especially where being bare foot emphasizes any symptoms being caused by leg/foot abnormalities)
Causes of Iliotibial Band Syndrome:
ITBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:
- Always Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
- Inadequate warm-up or cool-down
- Excessive up-hill and down-hill running
- In cycling, having the feet “toed-in” to an excessive angle
- Running up and down stairs
- Hiking long distances
Abnormalities in leg/feet anatomy:
- High or low arches
- Supination of the foot
- Excessive lower leg rotation due to over-pronation
- The force at the knee when the foot strikes
- Uneven leg length
- Bowlegsor tightness about the iliotibial band.
- Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.
- Weak hip abductor muscles
- Weak/non-firing multifidus muscle
Treatments of Iliotibial Band Syndrome:
While pain can be acute to quite painful, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Anti-inflammatory injection is one of the effective form of treatment for Iliotibial Band Syndrome. In severe cases where a conservative approach has failed, surgery can be a good option.