Iliotibial Band Syndrome: Causes, Symptoms and Treatment

Iliotibial Band Syndrome: Causes, Symptoms and Treatment

Overuse injuries are common in runners. They can be caused by many things, including running technique, unsatisfactory footwear, strength and flexibility deficits, past injury history or just by overtraining when your body isn’t ready.

Iliotibial Band Syndrome (ITBS) is a common overuse injury amongst runners. It can also develop in cyclists and walkers. The iliotibial band is a band of connective tissue that runs down the thigh from the hip to the shin. ITBS occurs when the iliotibial band becomes overloaded and irritated at the outside point of the knee. When this irritation persists, inflammation can develop, and it can progress into persistent lateral knee pain. It can be debilitating and can sideline someone for weeks or months.

What causes Iliotibial Band Syndrome?

ITBS is often caused by activity that repeatedly loads the knee in slight knee flexion (knee bend). As the iliotibial band comes close to the knee, it becomes narrow, and friction can occur between the band and the bone. This is what causes the irritation and inflammation associated with ITBS. Most ITBS sufferers are runners, and it can affect both experienced athletes and beginners. It can often be difficult to determine why the IT band has become painful. It most commonly occurs with overtraining, where someone has attempted to progress their training too quickly. It can also be driven by inappropriate footwear, running on an asymmetrical camber surface e.g. in one direction on the beach or sometimes a lack of variation in running (i.e too many track workouts). Additionally, if someone lacks strength or flexibility around their knee, hip, ankle or core, they will be at risk of developing ITBS.

Symptoms of Iliotibial Band Syndrome

The typical symptom of ITBS is pain and occasionally swelling on the outside of the knee. The athlete will often have pain later on in their run and will notice it more with descent of stairs and hills.

Can you prevent Iliotibial Band Syndrome?

Your Physiotherapist can use close physical and biomechanical assessment to identify and diagnose the driver of your pain. The history of the problem is very important in formulating a diagnosis. It is important to accurately diagnose your problem – noting that a number of other problems and structures can cause pain at the outside of the knee.

There are preventative measures you can take to help prevent ITBS.  These are:

  • Warm up properly. This measure is a given for any sport. A proper warm-up decreases your risk of injury and for a runner, they should consider walking for a short period prior to running.
  • Manage and progress your exercise volume appropriately:ITBS can often be a sign of overdoing it, and it’s not a condition that can be ‘run out’. Anyone feeling pain outside the knee should consider their training volume, and seek the help of a professional if unsure.
  • Wear appropriate and comfortable footwear: Frequent runners should not compromise on footwear and replace shoes that are worn on the outside of the sole. Current evidence regarding shoes for runners supports the use of shoes that are most comfortable for the individual.
  • Don’t run on hard or angled surfaces: When running, avoid hard surfaces like concrete or any surface that will cause your foot to repeatedly angle in one direction and irritate the IT band.
  • Biomechanical and physical analysis: Analysis of both your walking and running technique is called ‘gait analysis’ and can identify any biomechanical issues that may be contributing to irritation of the IT band. Assessment of your lower limb and trunk strength and flexibility is also very relevant.

Physiotherapy for Iliotibial Band Syndrome

If you suspect your pain is caused by ITBS, it is important you seek the help of your Physiotherapist. An accurate diagnosis is crucial for a timely recovery. The problem can become persistent, sidelining athletes for weeks and even months if not well managed. Your physiotherapist will utilise a number of tests and a physical assessment to accurately diagnose your problem. Relative rest (not necessarily complete rest) is important in the early stages of ITBS. For example, reducing your running volume or eliminating hills from your runs. Your therapist can guide these changes. Applying ice and compression to the knee can be helpful to numb the local tissues and reduce the pain response.

Typically physiotherapy treatment for ITBS may involve:

  • Reducing pain and inflammation in the area
  • Identifying the driver of the pain i.e biomechanical review
  • Recommendations to improve running technique
  • Recommendations to manage running and training load
  • Massage of the associated muscles and tissues of the IT band
  • Manual therapy of other relevant areas of the body that may be contributing to the problem e.g. lower back
  • Exercise recommendations to strengthen the knee, hip and ankle in order to improve knee function and prevent recurrence

If you are suffering from knee pain or suspect you may have ITBS, it’s important that you see one of our physiotherapists early to prevent further inflammation and ensure correct diagnosis. Please don’t hesitate to call St Leonards Physiotherapy on 9438 1782 if you’d like to chat with a physiotherapist directly.