Iliotibial band syndrome

Iliotibial Band Syndrome, aka ITBS or ITBFS (for Iliotibial Band Friction Syndrome), is a common injury generally associated with running. Additionally it can also be caused by biking, hiking or weight-lifting (especially squats).

Definition

Iliotibial Band Syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, 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, moving from behind the femur to the front of it during the gait cycle. The continual rubbing of the band over the bone, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed or the band itself may become irritated.

Symptoms

The symptoms range from a stinging sensation just above the knee joint on the outside of the knee or along the entire length of the iliotibial band to swelling to a thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately, but will worsen during activity when the foot strikes the ground if you overstride or run downhill, and may persist afterward. A single workout of excessive distance or a rapid increase in weekly mileage can aggravate the condition, especially if other predispositions exist.

ITBS can also occur at the hip joint, where the IT band connects to the hip. It is less likely to occur at the hip as a sports injury. It can commonly occur during pregnancy, as the connective tissues loosen to allow for delivery at the same time the women gains weight, adding more pressure. The hip version also commonly affects the elderly. This version is much less-commonly studied and few treatments are generally known.

Causes of Injury

Iliotibial Band Syndrome is the result of both poor training habits, equipment and anatomical abnormalities.

• Running on a banked surface, such as the shoulder of a road or an indoor track, causes the downhill leg to bend slightly inward and causes extreme stretching of the band against the femur.
• Inadequate warm-up or cool-down.
• Running excessive distances or increasing mileage too quickly can aggravate or cause injury.
• Anatomical abnormalities such as bowlegs or tightness about the iliotibial band.
  • One common indicator of bowleggedness for runners is that the outside of your sneaker's heel will have excessive wear, compared to the inside.

Short Term Treatment

To treat functional problems resulting from poor training:

• Decrease mileage.
  • For chronic problems, stop running altogether for 3-4 weeks.
• Limit climbing stairs or any activity that puts pressure on the knee while it bends (e.g. squats).
• Ice knee after activity.
• Alternate running direction on a pitched surface.
• Lateral sole wedge (orthotics) to lessen pressure on the knee.
• Stretching to tolerance.

Staying in Shape while Not Running

If you don't want to lose all your conditioning, try some of the following:

• Deep-water pool running
• Swimming with any kick except the "frog kick", whose whip-like action could aggrevate your IT.
• Speed walking with straight legs on flat surfaces.
• Cross-country skiing, especially on machine (keep legs fairly straight).
• Pleiades
• Yoga

Sports Activities to Avoid while you're Symptomatic

• StairMasters
• Dead-lifts
• Step Aerobics
• Court sports, such as tennis, racket ball, squash, basketball

Long Term Treatment

To treat structural abnormalities such as a natural tightness in the band:

• Stretching, especially before working out, to make the band more flexible and less susceptible to injury.
• To check for anatomical abnormalities, have a physical therapist familiar with ITBS videotape your running form on a treadmill and look at your body mechanics.
• In extreme cases, surgery to relieve tightness in the band. However, surgery is not always effective.

Both structural and functional problems need to be considered when treating Iliotibial Band Syndrome.

After the Pain is Gone

• You should not start running as soon as the pain stops.
  • If you have chronic ITBS, you may have to wait 2 weeks after the symptoms are gone.
• Restart running with minimal mileage, building slowly.
  • As you build your mileage, stop as soon as you feel pain.
    • Even better, try to stop running before the pain starts.
• Continue stretches, as well as strengthing of your quads and glutes.

Additional Treatment Options

• Deep-tissue massage or Rolfing may help break up scar tissue that forms.
• Non-steroidal anti-inflammatory drugs (aka NSAIDs), in high doses for a period of weeks, can help reduce the inflammation.
• Strengthening exercises for the quadriceps femoris and gluteus medius muscles can help support the leg, thus lessening the load on the ITB.
• Cortisone shots have been used to help reduce the inflammation, though some risks are involved with this treatment.

Disclaimer

As with any injury or ailment, you should see your doctor or physical therapist for diagnosis and treatment, rather than relying solely on advice you get from the Internet.

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Information provided by the American Running and Fitness Association, and other sources.

References and Links Sports Medicine Tent: ITB