Iliotibial Band Syndrome
By: Erin Ludwig, MS, ATC, VAT/L
Supervisor of Athletic Training Services, Hampton Roads
The Iliotibial band (ITB) is a thick piece of connective tissue that runs parallel to the femur from the hip to the knee. It attaches along the gluteus maximus and tensor fasciae latae on the side of the hip and connects on the lateral side of the tibia. The ITB is a remarkable structure that plays a critical role in human locomotion, especially when it comes to running. The ITB primarily functions to stabilize the hip and knee during movement. When the ITB isn’t working properly, movement of the knee (and therefore, running) becomes painful. This pain is what is usually diagnosed as Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners.
Iliotibial Band Syndrome (ITBS)
ITBS is characterized by pain along the outside of the knee near the lateral femoral condyle. It is the leading cause of lateral knee pain in runners and only second to patellofemoral pain syndrome as the chief cause of knee pain in this population. When the iliotibial band comes near the knee, it becomes narrow, and rubbing can occur between the band and the bone. This causes inflammation and pain. In severe cases, the pain can be sharp and lead to gait abnormalities, which may result in walking with a straightened knee as means of protection. Runners will usually describe pain on the outside part of the knee or lower thigh, often worsened by going up or down stairs, or getting out of a car.
Common Causes of ITBS
Predisposing factors for the development of IT band inflammation include training error and abnormal biomechanics. ITBS can result from any activity that causes the leg to turn inward repeatedly. This can include wearing worn-out shoes, running downhill or on banked surfaces, running too many track/running workouts in the same direction, or simply running too many miles. Some runners make the mistake of only running on one side of the road. Most roads are higher in the center and slope off on either side. The foot that is on the outside part of the road is therefore lower than the other. This causes the pelvis to tilt to one side and stresses the IT band. The biomechanical abnormalities that may lead to IT band problems are, excessive pronation of the foot, leg length discrepancy, lateral pelvic tilt, and “bowed” legs. Tight gluteal or quadriceps muscles may also contribute. ITBS is more common in women possibly, because some women’s hips tilt in a way that causes their knees to turn in. Unlike many overuse injuries, ITBS afflicts seasoned runners almost as much as beginners.
Treatment and Prevention of ITBS
Treatment consists of relative rest, ice massage, addressing any biomechanical or training errors, and gentle stretching. Once you notice ITB pain, the best way to get rid of it for good is to rest immediately. That means fewer miles, or no running at all. In the majority of runners, resting immediately will prevent pain from returning. If you don’t give yourself a break from running, ITBS can become chronic. While you’re backing off on your mileage, you can cross-train. Swimming, pool running, cycling, and rowing are all good ways to provide your body with relative rest. On the other hand, stair-climbing is not, because it is too much like running.
When doing the IT band stretch the “pulling” sensation is usually felt along the mid to upper thigh. Don’t worry if this doesn’t seem to hit the spot exactly where the pain occurs. The IT band is a long structure and the goal is to get it to loosen and lengthened. Along the same lines, gentle stretching of the gluteal muscles will also help.
Prevention of the IT band syndrome is achieved by running on a level surface or alternating directions on the road, a balanced approach to training which allows for rest and recovery, and preventive stretching. When running on a track, change directions repeatedly. Make sure your shoes aren’t worn along the outside of the sole. If they are, replace them. In some, strengthening the external hip rotators will help. This can be achieved by doing sets of one leg squats in front of a mirror. Watch pelvic alignment to ensure that one side does not drop. Finally, orthotics can be quite useful if you have a tendency to develop IT band inflammation.