Iliotibial Band Syndrome (ITBS)

Iliotibial band syndrome (ITBS) is an injury that has been seen over the past few years with increasing frequency, generally associated with running, cycling, hiking or weight-lifting. Knee pain and knee injuries, as a result of Iliotibial Band Syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints. ITBS is one of the leading causes of lateral knee pain in runners.

What is Iliotibial band?

The Iliotibial band (ITB) is actually a long tendon (tendons connect muscles to bone). It attaches to a short muscle at the top of the pelvis called the tensor fascia lata. The ITB runs down the side of the thigh and connects to the outside edge of the tibia (shinbone) just below the middle of the knee joint. You can feel the tendon on the outside of your thigh when you tighten your leg muscles. The band is crucial to stabilizing the knee during running, moving from behind the femur (thigh bone) to the front while walking.

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 thigh bone). The continual rubbing of the band over the lateral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

What are the symptoms of ITBS?

The symptoms include:

• Stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band).
• Tightness in the iliotibial band.
• Pain normally aggravated by running, particularly downhill.
• Pain during flexion or extension of the knee, particularly when pressing in at the side of the knee over the sore part.
• Weakness in hip abduction.

What are the causes for ITBS?

Common causes include:

• 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,
• Exercising on hard surfaces, like concrete,
• Exercising on uneven ground,
• Beginning an exercise program after a long lay-off period,
• Increasing exercise intensity or duration too quickly,
• Exercising in worn out or ill fitting shoes,
• Excessive uphill or downhill running,
• Overpronation (feet rotate too far inward on impact) of the foot.

ITBS can also occur where the ITB 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.

What can I do about it?

Treatment for this problem should include:

• Rest, Ice, Compression and Elevation (RICE) is the first line of treatment.
• Runners need to reduce running mileage and be alert to the signs of overtraining syndrome.
• Apply ice to the knee (for 10 minutes every 2 hours) in order to reduce the inflammation.
• Anti-inflammatory medications may also be used to reduce painful inflammation.
• Side Stretching can also help. To perform side stretching while standing, place the injured leg behind the good one. If the right side is the sore side, cross your right leg behind your left one. Then lean away from the injured side towards your left side. It is preferrable to have a table or chair that you can hold onto for balance on that side. Be careful not to overstretch. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times.
  
• Avoid crowned surfaces or too much running around a track.
• Shorten your stride.
• Wear motion control shoes to limit pronation or if you have been wearing motion control shoes, try less controlling shoes.
• Strengthen your hip abductors. You can test the hip abductor's strength by trying to balance on one leg. You will probably find it difficult to balance on the affected leg. You can strengthen your hip abductor muscles by standing on one leg and lifting or tilting the other hip upward. Keep the knee straight on the leg you are standing on.
  

The body is an amazing piece of evolutionary engineering but, while it is flexible, it will not tolerate abuse indefinitely. Always listen to your body and rest when appropriate, or shift the focus of your training to another part of your body.