Iliotibial Band (ITB) syndrome is a condition that often causes pain in the outside of the knee. The ITB itself is a thick connective tissue that originates at the hip and inserts into the knee; it is composed of the tendinous portions of the Tensor Fascia Latae and Gluteal muscles. The ITB’s purpose is to stabilise the knee joint and assist with movement
Anatomy
The ITB is a large thick band of fasia, that originates at the anterolateral iliac tubercle of the exernal lip of the iliac crest & inserts into the lateral condyle of the tibia at the Gerdy’s tubercle. Meaning it begins at the top part of your pelvis, runs down the lateral side of the thigh & attaches at the top of the shinbone, just under the knee cap. It is composed from the Tensor Fascia Lata & Gluteal muscles, then becomes proportionately thickened before attaching into the knee. This thick fibrous sheath then helps to stabilize the lateral side of the knee during flexion & extension, as well as aiding with hip abduction. When the knee is in a flexed position, the ITB is behind the lateral epicondyle, as you start to straighten the leg the ITB then travels forward across the epicondyle.
Causes
ITB syndrome is an overuse injury that usually presents as pain in the lateral aspect of the knee due to inflammation of a portion of the band, most commonly near the knee. It is most common in runners due to the repetitive knee flexion and extension (bending and straightening) of the knee required.
When the knee repetitively bends and straightens, the band slides of the lateral femoral condyle of the knee, causing excessive friction and thus inflaming the band, resulting in pain. It has been found that individuals diagnosed with ITB syndrome often have thickening of the band itself, which inflames the space between the ITB and femoral condyle.
A number of training factors have been suggested to be risk factors for ITB syndrome:
- Excessive running in the same direction on a track
- Increased running mileage
- Downhill running
- Wearing worn out shoes with improper support
Symptoms
If you are suffering from ITB Syndrome you may notice;
- Sharp pain, particularly on the outside of the knee
- Pain when the knee is bent to approximately 30 degrees
- Tightness and reduced flexibility
- Tenderness on the outside of the knee
- Pain when running or cycling.
If you suffer with any of these symptoms and suspect you may have ITB syndrome, contact your GP or local Sports Therapist/ Physiotherapist who can complete a thorough assessment to determine a clear diagnosis.
Diagnosis
If you suspect you have ITB syndrome, it’s crucial to seek professional assessment from a qualified healthcare provider, such as a physiotherapist or sports medicine doctor. They will conduct a comprehensive evaluation, which may include:
- Medical History: This involves discussing your symptoms, their onset, and any activities that exacerbate or alleviate the pain. Your doctor will also inquire about your training habits, previous injuries, and overall health status.
- Physical Examination: The doctor will examine your knee, assessing for tenderness, swelling, and range of motion. They may also perform specific tests, such as the Noble Compression Test or Ober’s Test, to further evaluate the ITB.
- Imaging Studies: In some cases, imaging studies like ultrasound or MRI may be recommended to rule out other potential causes of knee pain or to assess the severity of the ITB inflammation.
Differential Diagnosis
It’s important to note that other conditions can mimic the symptoms of ITB syndrome, such as:
- Lateral meniscus tear: This involves damage to the cartilage cushion on the outer side of the knee, causing pain, swelling, and locking sensations.
- Biceps femoris tendinopathy: This condition involves inflammation or irritation of the hamstring tendons, leading to pain in the back of the thigh or knee.
- Patellofemoral pain syndrome: Also known as runner’s knee, this condition causes pain around the kneecap due to overuse or misalignment.
A thorough evaluation by a healthcare professional is essential to rule out these other conditions and confirm the diagnosis of ITB syndrome.
Treatment
Physical therapy (Physiotherapy) plays a crucial role in ITB syndrome treatment. A qualified therapist will develop a personalised plan that may include:
- Stretching Exercises: Specific stretches targeting the ITB, hip muscles, and gluteal muscles can help improve flexibility and reduce tension.
- Strengthening Exercises: Strengthening the hip abductors, gluteal muscles, and core can improve stability and reduce stress on the ITB.
- Manual Therapy: Techniques such as sports massage, medical acupuncture, myofascial release, and trigger point therapy can help alleviate pain and improve tissue mobility.
Pain Management
Over-the-counter pain relievers like ibuprofen or naproxen can help reduce pain and inflammation. In some cases, your doctor may prescribe stronger pain medications or corticosteroid injections for short-term relief.
Addressing Underlying Causes
ITB syndrome often stems from biomechanical imbalances or training errors. A thorough assessment by a healthcare professional can identify underlying issues, such as:
- Muscle weakness or tightness: Imbalances in muscle strength or flexibility can contribute to ITB syndrome. A qualified personal trainer or sports therapist can address these issues through targeted exercises.
- Training errors: Overtraining, sudden increases in mileage or intensity, or running on uneven surfaces can all contribute to ITB syndrome. Adjusting your training plan and incorporating proper warm-up and cool-down routines can help prevent future flare-ups.
- Footwear or orthotics: Improper footwear or underlying biomechanical issues may require orthotics or shoe modifications to correct foot mechanics and reduce stress on the ITB.
Exercises
ITB Syndrome Stretches:
-
IT Band Stretch (Standing):
- Stand with your feet shoulder-width apart.
- Cross the affected leg behind the other leg.
- Lean your torso away from the affected side until you feel a stretch along the outer thigh.
- Hold for 30 seconds, then repeat on the other side.
-
IT Band Stretch (Lying):
- Lie on your side with the affected leg on top.
- Bend the top knee and reach back with your hand to grasp your foot or ankle.
- Gently pull your heel towards your buttock until you feel a stretch in the front of your hip and thigh.
- Hold for 30 seconds, then repeat on the other side.
-
Hip Flexor Stretch:
- Kneel on one knee with the other foot flat on the floor in front of you.
- Lean forward, keeping your back straight, until you feel a stretch in the front of the hip of the kneeling leg.
- Hold for 30 seconds, then repeat on the other side.
-
Glute Stretch (Pigeon Pose):
- Start in a push-up position.
- Bring one knee forward and place it on the floor just behind your wrist, with your foot angled outwards.
- Extend the other leg straight behind you.
- Lean forward over the front leg until you feel a stretch in the outer hip and buttock of the front leg.
- Hold for 30 seconds, then repeat on the other side.
ITB Syndrome Exercises:
-
Clamshells:
- Lie on your side with knees bent and feet stacked.
- Keeping your feet together, lift your top knee open like a clamshell.
- Slowly lower back down.
- Repeat for 10-15 repetitions on each side.
-
Side-Lying Leg Raises:
- Lie on your side with legs extended.
- Lift your top leg up towards the ceiling, keeping your hips stacked and core engaged.
- Slowly lower back down.
- Repeat for 10-15 repetitions on each side.
-
Foam Rolling:
- Place a foam roller under the outer thigh of the affected leg.
- Slowly roll back and forth over the IT band from hip to knee.
- Hold on tender spots for 30 seconds.
-
Single Leg Squats:
- Stand on one leg with your knee slightly bent.
- Slowly lower yourself down as far as comfortable, keeping your knee aligned with your toes.
- Push back up to the starting position.
- Repeat for 10-15 repetitions on each leg.
Important Considerations:
- Consult a healthcare professional before starting any new exercise or stretching routine, especially if you have any underlying medical conditions.
- Perform stretches and exercises gently and gradually increase the intensity and duration as tolerated.
- Listen to your body and stop any activity that causes pain.
Remember, consistency is key! Regular stretching and strengthening exercises can help prevent ITB syndrome from recurring and keep you moving pain-free.
Please see some exercise examples in our video.
Coming Soon..
If you feel like you are experiencing issues with your IT Band and would like to speak to one of our professional physiotherapists or sports therapists then our team can help. We have specialists covering a number of locations in the UK such as Birmingham, Manchester, Liverpool, Gloucester, Leeds, Wolverhampton, Derby, Nottingham, Leicester, Colchester, Maidstone and London. For more information you can contact us via our contact page.
