Iliotibial Band Friction Syndrome (ITBFS)
What is the Iliotibial Band?
The iliotibial band is a thick band of tendinous tissue that runs from the top of the pelvis (Ilium), down the outside of the thigh, and attaches to both the tibia and fibula beneath the knee. The ITB passes over a small bony prominence on the outside of the femur, just above the knee where underlying structures are particularly sensitive. The ITB can act as both a mover and stabiliser of the knee, hip and pelvis. This structure unfortunately provides these roles very ineffectively, becoming overactive as a compensator if other muscles that should provide these roles are weak or inefficient, particularly the gluteal muscles, abdominals and quadriceps.
When the knee is straight the iliotibial band lies behind the axis of the knee joint. With the knee bent the iliotibial band lies in front of this axis. Therefore every time the knee bends and straightens, particularly when the knee is nearly straight, the iliotibial band makes a small movement backwards and forwards over the outside lower aspect of the thighbone, each time moving over the small prominence of bone. With hundreds, if not thousands of repetitions of this movement; if training is inappropriate or biomechanics are altered, inflammation and degeneration can occur as pressure and friction from the band increases, leading to pain.
What are the symptoms?
Pain is the classic symptom of ITBFS, typically a worsening ache over a run or cycle which can be localised to the outer knee which can spread to a much larger area. Some athletes may report sensations of flicking over the outside of the knee, tightness in the outside of the thigh and sometimes mild swelling around the outside of the knee. Symptoms are often worse on stairs, and are particularly noticeable when running downhill due to the angle of the knee. A tightened and dysfunctional ITB may also manifest in pain over the outside of the hip, as it passes a bony point here too, potentially causing inflammation.
What is the cause?
The two major causes of ITBFS, like other overuse injuries, are inappropriate training and abnormal biomechanics.
What is the Treatment?
Physiotherapy is the most effective form of treatment for ITBFS. The Physiotherapist will be able to confirm the diagnosis and rule out other potential causes of the pain with a history of symptoms and several tests including assessing at the way you move and run and be able to prescribe appropriate exercises and strategies to correct the cause of the irritation.
Localised deep tissue massage, stretches and the ‘ITB Roller’, a dense foam bolster often found in the gym or supplied by the physio, used to roll along the ITB with the body weight to massage and stretch the tight ITB, are all treatments likely to be used.
Depending on other muscle length and strength imbalances picked up by the physiotherapist, stretching of other muscle groups are likely, including the Hip Extensors and Flexors, Hamstrings and Calf. Strengthening exercises to particular muscle groups are just as important due to their contribution to the biomechanical alignment of the leg during running and cycling. Frequently in individuals with iliotibial band syndrome the gluteal and quadriceps muscles are weak, in particular gluteus medius which controls excessive inwards rotation of the leg during activity, and the deep and oblique abdominals which control spine and pelvis rotation. Your Physiotherapist will be able to prescribe the most appropriate strategies for this.
What else can I do?
The local application of ice is useful to help with pain and reduce inflammation. This should be applied for 15-20 minutes over the outside of the knee following pain provoking training. Anti - inflammatory cream or tablets may also be used.
A period of relative rest should be considered. On return to sport, training techniques must be examined to prevent a recurrence of the symptoms. The athlete can also help with symptoms by addressing the following:
1. Incorrect running shoes that don't provide the correct amount or type of control at the foot for that individual. This can be assessed if necessary by a podiatrist, and potentially controlled with the use of orthotics
2. Training intensity errors. Avoid drastic changes to training distances and intensities, or the sudden introduction of hills and cambered surfaces
3. Cycle set up. Incorrect foot angle and excessive height of the seat can contribute to problems. An assessment of bike set up with an experienced assessor may be able to correct this.
4. Avoid track running training in a single direction or repetitive running on cambered surfaces.