Iliotibial Band Syndrome - A runner’s biggest enemy

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    Overview

    Iliotibial Band (ITB) syndrome is a condition that often causes pain in the outside of the knee. The ITB itself is a thick connective tissue that originates at the hip and inserts into the knee; it is composed of the tendinous portions of the Tensor Fascia Latae and Gluteal muscles. The ITB’s purpose is to stabilise the knee joint and assist with movement

    Anatomy

    The ITB is a large thick band of fasia lata, that originates at the anterolateral iliac tubercle of the exernal lip of the iliac crest & inserts into the lateral condyle of the tibia at the Gerdy’s tubercle. Meaning it begins at the top part of your pelvis, runs down the lateral side of the thigh & attaches at the top of the shinbone, just under the knee cap. It is composed from the Tensor Fascia Lata & Gluteal muscles, then becomes proportionately thickened before attaching into the knee. This thick fibrous sheath then helps to stabilize the lateral side of the knee during flexion & extension, as well as aiding with hip abduction. When the knee is in a flexed position, the ITB is behind the lateral epicondyle, as you start to straighten the leg the ITB then travels forward across the epicondyle.

    Causes

    ITB syndrome is an overuse injury that usually presents as pain in the lateral aspect of the knee due to inflammation of a portion of the band, most commonly near the knee. It is most common in runners due to the repetitive knee flexion and extension (bending and straightening) of the knee required.

    When the knee repetitively bends and straightens, the band slides of the lateral femoral condyle of the knee, causing excessive friction and thus inflaming the band, resulting in pain. It has been found that individuals diagnosed with ITB syndrome often have thickening of the band itself, which inflames the space between the ITB and femoral condyle.

    A number of training factors have been suggested to be risk factors for ITB syndrome:

    • Excessive running in the same direction on a track
    • Increased running mileage
    • Downhill running
    • Wearing worn out shoes with improper support

    Symptoms

    If you are suffering from ITB Syndrome you may notice;

    • Sharp pain, particularly on the outside of the knee
    • Pain when the knee is bent to approximately 30 degrees
    • Tightness and reduced flexibility
    • Tenderness on the outside of the knee
    • Pain when running or cycling.

    If you suffer with any of these symptoms and suspect you may have ITB syndrome, contact your GP or local Sports Therapist/ Physiotherapist who can complete a thorough assessment to determine a clear diagnosis.

    Diagnosis

    Our therapists at LIVEWELL are highly qualified in assessing and treating musculoskeletal conditions; you may find that you would benefit from soft tissue therapy, particularly of the TFL and hip-flexors to reduce tightness and improve flexibility. We can also assist in determining whether your bio-mechanics need altering and helping with strength programmes to target the desired muscles.  With our areas of knowledge and expertise we can help you overcome ITB syndrome and have you back running pain free.

    Treatment

    The immediate goal when treating ITB syndrome is to reduce the local inflammation and thus limit the pain. Ice and anti-inflammatory medications may assist in the reduction in the initial pain, however the most important aspect of initial treatment is activity modification. It could simply be that the individual needs to cease downhill running or running in one direction on a track- educating the individual on correct running techniques is very important.

    Once the inflammation has subsided, a programme can be introduced to begin strengthening the gluteal muscles and stretching the TFL/ITB complex. When the gluteal muscles do not function correctly, other muscles must compensate and perform work that they are not suited for.

    Exercises

    If you believe you have ITB Sydrome, you should firstly rest your leg & apply ice to the lateral side of knee joint. As it is an overuse injury initially reducing the load on the structure can help to relieve pain. When the pain starts to ease, some stretching and strengthening exercises can help improve symptom’s and aid recovery.

    Please see some exercise examples in our video.

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