Iliotibial Band Syndrome (ITBS) is one of the leading causes of lateral knee pain on the outer side of the knee, which can radiate up the thigh.
It is a common cause of running knee pain, frequently affecting long distance runners and can be notoriously difficult to treat. This condition is also known as Iliotibial Friction Syndrome, ITB syndrome or ITBS and is often misdiagnosed as Runners Knee.
The Iliotibial Band (ITB) is a thick band of fibrous tissue that
runs down the outside of your leg from your pelvis to your knee. It has a different structure to muscles, making it less mobile and harder to stretch. Some
of the buttock and hip muscles attach to it, and the ITB co-ordinates
how these muscles work as well as stabilising the knee and leg.
Here we will look at the causes, symptoms, treatment options, and prevention strategies for Iliotibial Band Syndrome.
Iliotibial Band Syndrome develops when the ITB gets irritated and inflamed due to friction. This most commonly happens on the outer side of the knee.
As the leg bends and straightens, the ITB glides over a bony lump on the side of the knee that sticks out slightly, the lateral epicondyle. A bursa (small fluid filled sac) sits between the ITB and the bone to allow smooth, gliding movements, but if there is too much friction, the Iliotibial Band gets irritated. When it is irritated, friction from walking and running can cause inflammation and pain to develop.
Inflammation of the ITB usually occurs from overuse and is most commonly seen in runners, especially those who do long distance running. Certain factors can make you more prone to developing Iliotibial Band Friction Syndrome:
1) Muscle Problems: Tightness in the leg muscles and the Iliotibial Band itself increases the friction on the ITB. Weakness in the buttock muscles (glutes) puts more strain on the Iliotibial Band, increasing your chances of developing Iliotibial Band Syndrome
2) Biomechanics: Anything which changes the normal position of the leg can place more strain through the ITB. If you have flat feet
(dropped foot arches), a leg length discrepancy (one leg longer than the other) or bowed legs (increased curvature of the legs) you are more prone to developing ITM syndrome
3) Running: Long distance running can also lead to Iliotibial band syndrome due to repetitive friction.
Lots of running surfaces e.g. roads and running tracks are slightly
banked. The foot position on the lower leg causes the Iliotibial band
to be stretched making it more prone to damage. Running up and down hills also puts even more tension through the ITB
4) Sudden increase in activity: Someone who rapidly increases their training is at risk of developing Iliotibial Band Syndrome due to the sudden increase in friction at the knee
The main symptoms of Iliotibial Band Syndrome are:
1) Lateral Knee Pain: pain over the outer side of the knee, especially when the heel strikes the floor. The pain is worse with running and stairs, especially when going down. It may also hurt to bend and straighten the knee.
2) Swelling: on the outer knee due to inflammation or thickening of the Iliotibial band
3) Popping/Snapping sensation: this can occur when you bend the knee as the ITB flicks over the lateral epicondyle
As with any overuse injury, it is really important to work out what caused the Iliotibial band to become inflamed in the first place. A physical therapist/sports injury specialist should be able to assess this for you. It can take several weeks/months to recover fully from Iliotibial Band Syndrome.
The initial aim of treatment is to reduce the inflammation which will in turn also reduce the pain. This is most effectively done using:
1) Rest: It is important to give the ITB time to heal so aggravating activities should be avoided. It’s not that you would cause major damage if you kept training, but you will significantly slow down your recovery. This is one of those times when the mantra “No pain, no gain” does NOT apply! Visit the Rest it Right section for guidance on the how to rest, but remember in this case, if an activity hurts, stop doing it!
2) Ice: Ice therapy can be used to help reduce inflammation, but only when used correctly. Visit the
section to find out how to get the maximum benefit from using ice and the ice wrap section for the best ways to apply ice
3) Anti-inflammatories: Medications such as ibuprofen can be helpful in reducing pain and inflammation with ITB syndrome
4) Change Your Sport: If your symptoms are aggravated by running, you might find that switching to activities like swimming or cycling allow you to keep exercising without aggravating the Iliotibial Band.
Long term treatment aims to address the cause of the Iliotibial Band Syndrome and may include:
1) Strengthening Exercises: Strengthening the glutes, quads and hamstrings improves how the hip and knee function which reduces the friction on the Iliotibial Band. Visit the knee strengthening section for exercises that will help
2) Stretching Exercises: The best place to start is with ITB stretches, but should not be done in isolation. Stretching the quads, hamstrings and calf muscles also helps reduce the friction at the knee. Visit the
section for simple tests to see if tight muscles is likely contributing to your ITB Syndrome and loads of great ways to stretch each of the muscles
3) Knee Straps: Wearing a brace that straps around
the top of the knee directs forces away from the Iliotibial band so can
be very helpful to reduce irritation when running. Visit the
section to find out which ones work best
4) Taping: Taping can also be used to reduce the forces going through the ITB – see you physical therapist/ sports injury specialist for more information
5) Massage: Deep tissue massage to the Iliotibial Band can reduce tightness, but it can be quite painful. It should be carried out by a trained sports therapist or physical therapist and should be followed up with an exercise programme
6) Injections: If other treatments have failed, a cortisone injection can be given to help reduce pain and inflammation. However it should always be accompanied by strengthening and stretching exercises to ensure the problem doesn’t return
7) Orthotics: Special insoles can be worn in your shoes to correct poor foot positions such as flat feet and thus take the tension of the ITB. See an orthotist for a full assessment and advice
8) Surgery: This is extremely rare and is only considered if all other treatments have failed. It is done arthroscopically (keyhole surgery) and aims to break down any scarring in the tissues and if necessary lengthen the Iliotibial band to reduce the friction at the knee.
The most common cause of Iliotibial Band Syndrome is running. In order to prevent ITB syndrome from developing or recurring runners should ensure they:
1) Warm up and cool down properly: including stretching. Visit the stretching section for guidance on how to stretch effectively: most people don’t stretch properly.
2) Wear good running shoes
3) Wear orthotics if required: to correct any abnormal foot positions or leg length discrepancies
4) Avoid training errors: such as avoiding running in the same direction on banked surfaces and slowly increasing distances.
There are a number of other causes of lateral knee pain as well as Iliotibial Band syndrome. If this doesn’t sound quite like your problem, visit the knee pain diagnosis section for help working out what is wrong with your leg.