Iliotibial Band Syndrome (ITBS) is one of the most common injuries in runners presenting with lateral knee pain, with an incidence estimated to between 5% and 14%. Studies indicate ITBS is responsible for approximately 22% of all lower extremity injuries. This blog post discusses what this syndrome is and how we can best manage it using the latest evidence based practice.
Anatomy & Source of Pain
ITBS is a common knee injury that occurs on the outer thigh with pain or tenderness on the outside of your knee near your joint line as seen in the figure below. This injury is considered a non-traumatic overuse injury often seen in runners and is often concomitant with underlying weakness of hip abductors (such as your glutes).
Traditionally this condition was thought to occur because of friction between the Iliotibial Band (ITB) and the underlying bone. It was once believed there was friction occurring on the ITB therefore contributing to local inflammation and irritation of the bursa lying between the ITB and bone. However current research does not support this idea and the bursa being present around this region. Instead it is believed that a richly innervated and vascularised layer of fat is compressed, therefore causing the source of pain in this syndrome.
How did I get this pain?
ITBS can be caused by many mechanisms such as running on slopes for long periods of time, leg length differences, poor foot structure, excessive shoe breakdown, training intensity errors, muscle imbalances or poor running/gait mechanics.
Individuals such as runners may experience the symptoms due to significant weaknesses present within the hip abductors along with decreased ability of these muscles to control the coordination of your hip and knee also known as “neuromuscular control”.
What are the symptoms?
A visit to your physiotherapist will help to assess your current symptoms by performing a subjective and physical assessment which will guide diagnosis for this condition. Clients will often experience the following symptoms:
Burning sensation or sharp pain on the outer aspect of your knee which can radiate into your thigh or calf.
Possible pins and needles or stinging occurring when your heel strikes the ground – progressing eventually increasing difficulty of walking or experiencing symptoms with stairs.
Tenderness along the mid-portion of the tendon along with over the insertion of the tendon on your lower leg just below “area of pain” in the first picture above.
Snapping or popping sound at the knee, along with swelling around the knee.
Increasing distance of running or walking exacerbates pain as well as running on slopes.
What’s the best management?
Best practice physiotherapy currently involves treatment along each specific segment of the kinetic chain which spans from addressing foot alignment to hip biomechanics to achieve desirable long-term results.
Hip biomechanics are a likely cause of this syndrome therefore strengthening and training neuromuscular control of the hip and knee proves to be beneficial for a condition such as ITBS. Currently exercises involving your gluteus maximus and gluteus medius are effective at improving the causes of pain. This includes exercises such as the following.
Glute Med Wall Activation with Hip hinge: Hinge forwards at the hips whilst maintaining a slight bend in the stance leg, a neutral spine, engaged core and glutes throughout the movement. Non-affected leg pressing into wall to stabilise.
Hip Hike/Hip Airplane: Stand on the affected leg and hinge forward at the hips, maintain a slight bend in the knee activate your core and glutes. Begin to rotate and open your hips while controlling the movement at your hips. Bring your hips back to centre and begin to rotate in the opposite direction.
Side-Lying Clam: Affected leg on the top, bring your knee’s apart and squeezing your glutes to open up the hips.
Single leg Sit to Stand: Ensure good hip and knee control during this movement, knees should be tracking over second toe and avoid collapsing inwards.
Along with exercise, strengthening and neuromuscular re-education is also important. Your physiotherapist should use a multifaceted treatment approach, including the introduction of correct running form, exercising on appropriate surfaces (avoiding uneven surfaces), correct footwear and adequate scheduling for activities such as running programs.
For a more tailored and individualised approach, visit your physiotherapist or give us a call on 3061 7128.
If you are interested in finding out more about running pathologies feel free to check out our blog about Runner's Knee.
Blog and videos by UQ Physiotherapy student undertaking clinical placement, supervised by principal physiotherapist, Winnie Lu.
Principal Physiotherapist
Souths United Football Club Physiotherapist
References
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Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15-S21. doi:10.3949/ccjm.84.s1.03
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