Iliotibial band syndrome
|Iliotibial band syndrome|
|Classification and external resources|
Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats).
Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a thick band of fascia on the outside of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.
ITBS symptoms range from a stinging sensation just above the knee joint, to swelling or thickening of the tissue in the area where the band moves over the femur. The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time. Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia.
Physical activities to avoid while symptomatic
- Stair climbing
- Deadlifts or squats
- Court sports, such as tennis and basketball
- Martial arts, such as karate
- Kite surfing
- Downhill Skiing
ITBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:
- Consistently running on a banked surface, which causes the downhill leg to bend slightly inward, causing extreme stretching of the band against the femur (such as the shoulder of a road or an indoor track)
- Inadequate warm-up or cool-down
- Excessive up-hill and down-hill running
- Positioning the feet "toed-in" to an excessive angle when cycling
- Running up and down stairs
- Hiking long distances
Abnormalities in leg/feet anatomy:
- High or low arches
- Supination of the foot
- Excessive lower leg rotation due to over-pronation
- Excessive foot strike force
- Uneven leg length
- Bowlegs or tightness about the iliotibial band.
- Weak hip abductor muscles
- Weak/non-firing multifidus muscle
 While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. An ultrasound machine can be used to relax the inflamed area, followed by a machine that utilizes electrode stimulation to the area to further relax it. This can result in improved comfort and/or a wider range of motion in the area. Consulting with a doctor, a registered physiotherapist, a podiatrist, an athletic trainer, or a massage therapist, would be among the best solutions. Custom foot orthotics may treat ITBS condition by controlling the amount of medial rotation of the foot, thus reducing rotation of the leg and knee. Excessive rotation of the leg and knee creates friction of the iliotibial band against the outside of the knee. A compression wrap can be used to help stabilize the area of the knee where the tendon meets the patella. Steroid injections can also treat ITBS; severe, treatment-resistant cases may require surgery to immobilize the band.
- Martens, M., Libbrecht, P., Burssens, A. 1989. Surgical treatment of iliotibial band friction syndrome. Am J Sports Med, 17(5):651-654.