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What is Iliotibial Band Syndrome?
Causes & risk factors
Symptoms
Diagnosis
Treatment
If you ignore ITB syndrome
Prevention
FAQs

What is Iliotibial Band Syndrome?

The iliotibial band (IT band) is a thick band of fibrous tissue that runs down the outside of your thigh, connecting your hip to your knee. This tissue is essential in stabilising your knee, preventing it from caving inwards during movement.

When the band is overused or overloaded, it results in a painful condition known as iliotibial band syndrome (ITB syndrome). 

Causes & Risk Factors

ITB syndrome is an overuse injury, occurring when the band repetitively rubs over the femoral epicondyle (the bone you can feel on the outside of your knee) as the knee bends and straightens. If your IT band is too tight, then this repetitive action can create friction, causing it to become irritated and inflamed. This results in a nagging pain on the outside of your knee.

It mostly occurs in the sports of; running, cycling, rowing, football, soccer, hockey and netball. Basically in people who participate in sports/exercise which require the knee to bend repetitively and constantly.

This injury may be caused by one or a combination of issues. For example:

• Changes in your training or activity that involves knee stability including;
  • Speed increases
  • Running up or down too many hills
  • Changes in running surfaces (particularly to harder surfaces)
  • Increased frequency of training
• Training errors including;
  • Training on uneven and sloping ground, where you run in one direction. This can have the same effect on the body as leg-length discrepancy, putting extra pressure on the "downhill" leg
  • Skipping out on recovery days or going too hard on a recovery run
  • Running through injury - Unfortunately the longer you have an injury, the longer it takes to heal
• Worn out footwear with limited cushioning, resulting in poor shock absorption.  
  • Instead of your footwear acting as a nice cushioned shock absorber, your muscle and tendons (i.e. your ITB) have to take over the job. If your ITB is not strong enough, or too tight, it can not cope with the extra load. 
• Excessive uncontrolled pronation movement in your feet and legs
  • This is when your arch and ankle collapse or "roll in" excessively and at higher speeds when you walk. Hence as the leg is connected to your foot and ankle, if they move in a particular motion, the rest tends to follow. Therefore, this can create a flow on effect and place increased stress and strain on areas above your foot and ankle, including the ITB. 
• Weakness's in your gluteal, hip or lower leg muscles
  • Unfortunately if these muscle aren't doing much work, the ITB has to pick up the extra load. 
  • Weakness commonly occurs in the hip abductors which are responsible for rotating the leg away from the body and stabilising the hip.
• ITB tightness
  • It can occur from avoidance/lack of stretching and/or foam rolling. 
• Certain anatomy issues including;
  • Leg-length discrepancy
  • Bowed legs
  • History of surgery 
  • Osteoarthritis
• Poor posture and bike set up for cyclists
  • Especially if you 'toe-in' when you pedal. If your toe clips are incorrectly aligned, this could force your feet to turn inward as you cycle, increasing the angle that your ITB crosses at your knee. 

Symptoms

The most common symptom of ITB Syndrome is pain at the outside of your knee. It is usually brought on by inflammation from exercise or physical activity.

Specific signs that you may have developed this injury include: 

• Sharp, burning or nagging pain at the outside of the knee
• Swelling on the outside of the knee
• Gradual or sudden pain that worsens when continuing to run or complete other repetitive activities
• Pain during knee bending or knee loaded activities e.g. running downhill or climbing stairs

If you're experiencing pain in another area of the knee, then one of these other conditions may the reason for your knee pain. 

Diagnosis

The signs and symptoms of ITB syndrome closely resemble those of tendonitis (inflammation of a tendon), so it's important that our podiatrists in Brisbane are able to correctly diagnose your condition.

To diagnose ITB syndrome, we would take into account your presenting signs and symptoms, before completing a physical assessment of the lower limbs and further specialised assessments. Diagnostic imaging may be required to rule out if any secondary bursitis has occurred. 

Treatment

The first course of action when treating ITB syndrome is to reduce your acute pain and inflammation. Once your pain has settled, we would then focus on repairing the damaged IT band by improving strength, mobility and flexibility. 

We do this by using a combination of the below treatments, based on what your injury requires.

• RICE - rest, ice, compression & elevation is effectful at managing and reducing your initial pain. Place the ice in a damp cloth or towel and ice the area for 10-15 minutes at a time. 
• Gait re-training to improve your control of your feet through balance and support
• Exercises to strengthen, especially focusing on the gluteal muscles and tensor fascia latae. 
• IT band stretches to reduce tension in the muscles of the hip and leg. 
• Maximising your exercise program or training regime including a plan of what days to train to provide adequate recovery.
• Dry needling of surrounding soft tissues structures to release tension in the muscles, by targeting trigger points. 
• Short term use of anti-inflammatory medication
• Foot mobilisation technique to mobilise the joints and bones of the foot and ankle to facilitate restoration of movement.
• Shockwave therapy is a non-invasive effective therapy that accelerates and facilitates the healing process. It works by emitting high energy acoustic wave pulses directly into the injured area. These waves stimulate;
  • New blood vessel and collagen formation 
  • Increased blood flow 
  • Resolution of calcium build up 
  • Pain reduction 
• Custom prescribed foot orthotics may be recommended to ensure your training regime is minimally impacted, whilst allowing your injury to heal. 

Below, we have outlined a few things you can try at home to help settle down those niggling symptoms. However, we recommend consulting with our podiatrists to get an accurate diagnosis and personalised treatment plan to ensure they are going to be effective for you. 

Strengthening exercise focusing on hip muscle groups

Modified wall sit

• Lean with your back against the wall and your feet approximately 0.5m from the wall (this may vary depending on your height)
• Slide your hips down the wall. Stop once your knee is at half the depth of a full squat (approximately 45 degree angle deep) and ensure knees are parallel
  • If your knees are in direct line with your ankles then you are in the right position
  • Important to note: please do not go to 90 degree depth (knees at right angles) this places increased load on your knee joint and tends to work the muscles less.
• Hold this position for 30 seconds, once daily. As this exercise gets easier, increase the time held. 

Gluteal Bridges

• Lie on your back on a yoga mat or flat even surface. 
• Bend both knees to place your feet flat on the ground 
• Lift your buttocks off the ground until your hips are flat 
• Hold this position for 1-2 seconds 
• Slowly lower over 3 seconds your buttocks back to the ground 
• Start with 2 sets of 10 repetitions once daily
• Increase the repetitions and sets as the exercise becomes easier 

Foam Rolling to release tight soft tissue structures

• We recommend foam rolling the back and front of the thigh and the buttock, lower back region. Gently roll out the tight muscle areas. 
• You may wish to avoid the tender areas of the IT Band as the direct pressure from the foam roller can be quite painful. 

What can happen if I ignore my ITB syndrome?

Unfortunately this is not an injury you can ignore and run through the pain. If you continue to exercise without making any changes to your routine or equipment, the pain and injury will continue to get worse until you can no longer run or train. The longer you leave it untreated the longer the recovery period. 

Prevention

There are a number of approaches you can take to prevent ITB syndrome.

• Avoid exercising on uneven surfaces and the edge of the road
• Ensure your training sessions have variance
• Avoid running up or down too many hills
• When looking to increase your training, do so gradually
• Continually strengthen and stretch your leg muscles
• Replace worn out footwear to ensure you're getting enough cushioning during exercise 
• When cycling, ensure you have good posture and a correct bike set up
• Use a foam roller to stretch the ITB post exercise to prevent tightness
• If you start to feel pain on the outside of your knee, take a couple of days to rest and recover

FAQs