What is Iliotibial Band Syndrome (ITB Syndrome)?
ITB syndrome or Iliotibial Band Syndrome, often referred to as “runners knee” occurs is when the band of fascia (collagen or connective tissue in other words) called the iliotibial band (ITB), which runs down the outside of the thigh, causes irritation to the outside of the knee. As the ITB passes over the knee joint it also goes over the top of a structure that has been cited as a bursa (a fluid filled sac) or other sources report the tissue as being more spongy in nature. This tissue is there to reduce friction between the ITB and the bony surfaces it comes in close proximity to. When the ITB becomes pathological it often causes compression of this structure which results in inflammation (swelling) and ultimately pain.
ITB Syndrome commonly presents with pain and/or increased tenderness on the outside of the knee. It is classed as non-traumatic injury, usually related to the overuse or over training.
Who does ITB syndrome affect?
Due to the mechanical and overuse nature of this injury it often affects runners and cyclists. It is more typical to see it in a younger and more active population but is not exclusive to this. It is also frequently seen in:
- Triathletes
- Basketball players
- Hockey players
What causes ITB syndrome?
There are various factors that can contribute to ITB Syndrome which could be considered in two categories, mechanical factors and training factors.
A mechanical factor could be weakness of the muscles areound the hip and pelvis where as a training factor could be introducing a new method of exercise at too high a frequnecy, i.e. running once a week to five times a week without adequate adaptation time being given.
Additional factors that can result in ITB syndrome developing include
- including excessive running in the same direction on a track
- increased weekly running mileage,
- downhill running
- weak hip and core muscles
- leg length discrepancy
- knee arthritis
- bowed legs
Signs and symtptoms of ITB syndrome
Common signs and symptoms of ITB syndrome include:
- a clicking sensation: feeling a snap, pop or click on the outside of the knee
- Knee pain: iliotibial band repeatedly rubs against the outer part of the knee when knee is flexed and extended. This friction can cause inflammation of the tendon and the pain of the knee
- warmth and redness: the outside of the knee might look discolored and warm to touch
- pain after exercise which progresses to being present on daily activities such as climbing or descending stairs or even at rest
How do you treat ITB Syndrome?
Treatment Initial treatment for ITB Syndrome aims to reduce pain and inflammation and address underlying causes.
Resting, icing and taking medication to relieve the pain is the key.
- rest: reducing or changing physical activity that is aggravating the pain, will allow the leg to heal
- icing: applying ice packs to the affected area for 10 minute durations taking care to protect the skin. Using a damp tea towel around the ice back helps to prevent ice burns
- medication: taking anti-inflammatory drugs (NSAIDs) can aid with pain and swelling reduction. Correct dosage should be discussed with a trained healthcare provider such as your GP or a Pharmacist or any registered prescribing clinician
Further treatment includes physiotherapy to help get you back to your regular activities. A physiotherapist will carefully assess your knee and body mechanics in order to understand what may have caused the problem to arise. From this information they can provide a rehabilitation programme to help strengthen weak muscles and improve control around the knee or any other contributing factors.
A rehabilitation programme may include exercises to improve strength of the glute, quadricep, hamstring and calf muscles and possibly core muscles.
Re-planning your training programme may be a relevant component of treatment to advise you on how to avoid overtraining.
Some manual therapy techniques can be used such as soft tissue/myofascial release around the interfaces of the ITB, Glute Max and Tensor Fascia Latae release and stretching to relevant structures.
Orthotics and taping can be useful to address any foot posture mechanics that may be involved.
These remedies tend to be sufficient to curing the problem, but if they aren’t successful there are additional treatments that can be implemented including:
- steroid injections: corticosteroids might reduce the inflammation in the ITB
- surgery: rare and is only recommended by the doctor if other treatments fail