Iliotibial band syndrome (ITBS), or Illiotibial band tendonitis, is a frustrating and troubling injury. Because of it’s common mechanism of injury involves repetitive knee flexion and extension, it is often associated with runners.
Personally, ITB syndrome has proved to be one of the most difficult injury that I’ve dealt with as an athlete.
The IT band is a sheath of dense fibrous connective tissue which originates on its upper end to the tensor fascia latae muscle on the upper outer thigh. The ITB extends down the lateral thigh and inserts into the outer surfaces of both the fibula and tibia bones of the shin. The function of the IT band is to help extend the knee joint, externally rotating the upper leg along with abducting of the hip.
Illiotibial band tendonitis is usually a result of the ITB being inflamed with excess friction of the ITB passing over the lateral epicondyle (the bony ridge on the outer distal thigh bone) of the femur (thigh bone). With a repetitive knee movement like running or secondary trauma, the rubbing of this tissue over the hard bony ridge will result in inflammation and movement discomfort.
Signs and Symptoms of Runner’s Knee/Iliotibial Band Syndrome
- Pain on the outside of the knee above, at or below the lateral knee joint line.
- An increased tenderness with palpation(note: palpation is a method of clinical examination using gentle pressure of the fingers to detect growths, changes and unusual tissue reactions)of the iliotibial band.
- An inability to squat through a full range of motion because of lateral distal thigh pain and weakness.
- Knee pain normally aggravated by running, particularly downhill.
- Pain during flexion or extension of the knee with both the foot on and off the ground.
How to Professionally Treat Iliotibial Band Syndrome
- Apply cold therapy with ice bags, ice massage or ice bath.
- Rest the knee and lower extremity from running, quad strengthening and painful activities.
- Implement self myofascial mobilization and massage techniques such as rolling the thigh, lateral thigh and calves.
- Aggressive flexibility of the IT band and the entire lower extremity including the ankle, great toe and low back.
- Lateral knee and thigh massage is an effective treatment to reduce painful ITB tightness.
- Assessing leg length and foot biomechanics bilaterally. It is common to trace the source of lateral knee pain to a leg length difference or excessive pronation involving one leg.(Pronation means that the feet roll inward and cause the ankles to turn in.)
- A thorough analysis of the athlete’s training program
Asking the Right Questions With Lateral Knee Pain
When faced with runner’s knee or Illiotibial band tendonitis, the wise professional athlete who wants to safely return to his/her sport and avoid further injury will ask his sports medicine specialist the following questions:
- Are you certain of the diagnosis?
- Do I need an MRI to rule out any other problems?
- What are the best options with treating this injury?
- What can I expect with this injury for the next 2, 4 and 6 weeks?
- Who do you consider to be the expert knee rehab specialist in this area?
- Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?
Tips For Successful Iliotibial Band Treatment
- Minimize the Damage – Illiotibial Band Syndrome is not an injury that you can just grit your teeth and run through. Be smart early and avoid creating additional injuries.
- Look Elsewhere – IT band tendonitis is often a result of a mechanical problem elsewhere. Look above: hip & low back…..or below:…arch, ankle or great toe. Don’t forget to look at your shoes!
- Ice is Your Friend – It’s a reality check: Ice hurts but it’s exactly what you need for this injury. The Pro’s will tell you that ice is their best teammate. Stop complaining and do what you know you need….ICE and lots of it.
- Lighten up, Coach! – An athlete suffering from IT Band Syndrome is usually training very hard. A common theme with this injury is that you do not have enough recovery time during the week or you are progressing too aggressively with your workouts. Getting your coach, which sometimes refers to YOU, to work with you on this is a key step in getting this painful injury in your rearview mirror. A thorough analysis of your athlete’s workout plan is a great start.
- How Long? – This may be one of the toughest injuries to put a recovery timeframe on. The downtime from lateral knee pain associated with IT Band Syndrome is significantly reduced if you treat the injury early and modify painful activities while treating the injury as noted above.