IT BAND FRICTION SYNDROME
Iliotibial band friction syndrome is also known as ITBS and runners knee. It is a common cause of pain on the outside of the knee.
What is the Iliotibial Band?
The ITB, or iliotibial band, is a long, thin band of fascia that runs down the outside of your thigh. At the top of your thigh it is attached to your Tensor Fascia Latae (TFL) muscle, and Gluteus Maximus and at the bottom it attaches to your tibia (lower leg bone) and femoral condyle on lower outside portion of the thigh bone.
What Causes ITB Syndrome?
Essentially ITB friction syndrome is caused by altered running biomechanics due to underlying muscular imbalances.Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.
The most common causes include:
- Poor biomechanics (running technique); particularly inwards rolling knees and hips
- Weak hip / gluteal muscles
- Weak hip rotators
- Weak inner quadriceps
- Weak core muscles
- Poor foot arch control
- Worn out or unsuitable runners
- Sudden increase in mileage for training
- Excessive hill training (particularly downhill)
- Endurance running (training for ½. and full marathons, ultra-marathons)
Symptoms & Diagnosis
Symptoms consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur. This is a bony protrusion on the outside of the knee. Pain usually develops gradually over time, becoming progressively worse. Typically the athlete will rest for a period of time until symptoms go, only for them to return when training resumes.
In runners, symptoms often occur at exactly the same time into a run and become progressively worse. After a period of rest, symptoms disappear only to return when the patient returns to normal training. Pain is made worse by running, particularly downhill.
Symptoms can often be reproduced when bending and straightening the leg, whilst pressing in at the side of the knee over the painful area.
Iliotibial band syndrome treatment & rehabilitation
Treatment for ITB friction syndrome involves reducing the pain and inflammation, identifying any underlying causes, then stretching and conditioning the muscle and iliotibial band along with a gradual return to full fitness so the injury does not recur.
Self-help treatment
Rest
Rest is important to allow the inflamed tendon to heal. Continuing to run with ITB syndrome will most likely make it worse. Initially, complete rest is a good idea but later activities other than running which does not make the pain worse such as swimming or cycling should be done to maintain fitness.
Apply ice
Apply cold therapy or ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until the initial pain has gone then later 2 or 3 times a day and/or after exercise is a good idea to ensure the pain does not return. Once the inflammation has gone then potential causes must be addressed such as a tight ITB or the pain will most likely return.
Identify possible causes
Errors in training should be identified and corrected. These can include overtraining or increasing running mileage too quickly. As a general rule, a runner should not increase mileage by more than 10% per week. Running across a slope or camber in the road for long periods or poor foot biomechanics should be considered. When training starts again, keep in mind to avoid too much downhill running.
Check your training diary for any significant increase in running mileage, change of surface, change of job or anything else out of the ordinary. Keeping a training diary allows you to look back and identify possible factors contributing to injury and therefore avoid them in the future.
Foam roller exercises
Using a foam roller on the IT band and gluteal muscles can help stretch the iliotibial band and remove any tight knots or lumps in the tendon and therefore, friction on the side of the knee. Self-massage techniques can also be very helpful in correcting excessive ITB tightness, especially where access to a massage therapist on a regular basis is not possible.
Preventing Iliotibial band syndrome
Return to full fitness gradually! This can often start within two weeks of initial treatment but will depend on the extent of the injury. Build up running time from a much lower point than you left off before the injury. A reduction to 50% of original mileage or time should be okay. Apply ice to the knee for 15 minutes after training, even if it doesn’t hurt. This will help keep any potential inflammation in check.
Increase running time rather than distance for the first few runs. Running distance should be increased by no more than 10% a week (depending on original fitness levels). If you feel pain or the inflammation comes back then go back a couple of steps to reduce the inflammation and start again.
It is important to continue to stretch and do foam roller exercises. If the Iliotibial band (ITB) is tight then the injury is very likely to recur. Simply reducing the inflammation will not cure the injury permanently. Even when fully fit it is a good idea to get a regular sports massage which will eliminate tight spots and knots that can cause the ITB to tighten.
ITB Surgery
In severe cases, some patients choose to undergo a surgical release of the iliotibial band which is called a Z-lengthening procedure. It entails removal of the irritating piece of structure that overlies the femoral condyle on the outside of the knee. This is a last resort as most cases respond well to conservative treatment or physiotherapy.
Post-operative rehabilitation is one of the most important aspects of surgery. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity.
