Iliotibial Band Syndrome

What is the iliotibial band?

Iliotibial band syndrome is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins at the hip and extends to the outer side of the shin bone (tibia) just below the knee joint. The band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint.

What is iliotibial band syndrome?

Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result.

What are the symptoms of iliotibial band syndrome?

As stated previously, the function of the iliotibial band is both to provide stability to the knee and to assist in flexion of the knee joint. When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

Why did I get iliotibial band syndrome?

People who suddenly increase their level of activity, such as runners who increase their mileage, often develop iliotibial band syndrome. Others who are prone to ITBS include individuals with mechanical problems of their gait such as people who overpronate, have leg length discrepancies, or are bow-legged.

Causes

Iliotibial Band Syndrome can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:

Training habits:

• 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
• Increasing distance too quickly or excessive downhill 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
• Overpronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or 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.

Muscle Imbalance:

• Weak hip abductor muscles
• Weak/non-firing multifidi muscles

What is the treatment for iliotibial band syndrome?

Treatment of ITBS begins with proper footwear, icing the area of pain, and a stretching routine. Limiting excessive training, resting for a period of time, and incorporating low-impact cross-training activities may also help. Anti-inflammatory medications may be prescribed by your doctor to help decrease the inflammatory response around the area of irritation. If these treatments do not solve the problem, working with a physical therapist to develop a more focused stretching and strengthening routine may help. Cortisone injection into the area of inflammation may also be attempted, usually after these other treatments fail. If all else fails, surgery is an option, but only in very rare circumstances.

After the pain is gone

• Continue stretching, as well as strengthening of the leg muscles.
• The patient should start running only after treatment.
• Restart running with small distances, building slowly.
• If the patient feels pain, he or she should stop.