Your iliotibial band (ITB) is one of your hip abductor muscles, responsible for moving your hip away from the midline. Essentially, it’s a long band of fascia that runs down the outside of your thigh. It starts at the iliac crest in your pelvis and runs right down until it crosses your knee to finally attach to the top part of your tibia (shin bone). It’s an important stabiliser for the lateral (outside) part of your knee, keeping it in the correct position as the joint flexes and extends. An ITB injury occurs when the band is overused, causing friction and pain.
What Is Iliotibial Band Syndrome?
The iliotibial band narrows as it gets close to the knee. This makes it more susceptible to inflammation and pain as a result of rubbing between the band and the knee joint. Iliotibial Band Syndrome (ITBS) is an overuse injury most common in runners and cyclists. It also occurs in weightlifters as a result of frequent squatting, and in rowers.
ITBS is caused most often by activities that cause the leg to repeatedly turn inward. In runners, this can include running downhill or on banked surfaces, wearing worn-out shoes, running on a track in the same direction too often, or simply just running too much. It’s more common in women, as the design of their hips can cause them to tilt in such a way that their knees turn in. Other causes include:
- Poor running technique
- Weak hip, gluteal, core or inner quadriceps muscles
- Poor foot arch control
An ITB injury differs from most other overuse injuries in that it occurs as often in beginners as it does in seasoned athletes. Being an overuse injury, it is caused by repeated trauma rather than one specific incident and actually accounts for over 20 percent of all overuse injuries in runners. One of the main reasons why it’s so common in runners is because the most friction occurs when the knee is bent at an angle of 30 degrees. This is usually the angle a runner’s knee is at just as their foot hits the ground.
What Are The Symptoms of IT Band Syndrome?
Because the most noticeable symptom of IT Band Syndrome is pain and swelling on the outside of the knee, many people initially mistake an ITB injury for a knee injury. The best way to self-diagnose is to bend your knee at a 45-degree angle – if you feel pain on the outside of your knee, then you know you have an ITB problem.
Specific symptoms to watch out for include:
- Swelling and/or sharp, burning pain on, or just above, the outside of your knee.
- Pain when you first start bending your knee
- Pain that worsens with continued running or other, repetitive activities
Symptoms can start gradually, but slowly get worse. If left untreated for about a month or more, they will significantly interfere with your ability to do sport or any other activity. If you experience any of the above symptoms for any length of time, it’s very important to see your doctor or a sports medicine physician. An X-ray often produces negative results, but an MRI scan can identify an ITB injury by picking up partial thickening of the band, caused by inflammation.
Treatment Of ITBS
RICE treatments (Rest, Ice, Compression and Elevation), combined with anti-inflammatory medication, are usually the first things a doctor will recommend. Rest is especially important for runners, who usually notice that the pain disappears the moment they take a break from running. Ignoring the pain can result in your ITB injury becoming chronic.
Physiotherapy treatment can also be effective in treating ITBS in the following ways:
- Strengthening your knee, leg and hip muscles
- Normalising your lower limb muscle lengths
- Reducing acute pain and inflammation
- Modifying your training regime to help prevent reoccurrence
Your physiotherapist may also give you exercises to do at home to supplement your physiotherapy sessions. These could include stretching, massage and using foam rollers at the site of your pain and inflammation.
Most cases respond well to these conservative treatments. However, if neither approach brings significant relief, then surgery might be recommended as a final option. It is only usually considered for patients with chronic inflammation. Surgical correction of an ITB injury involves releasing the iliotibial band. This is known as a Z-lengthening procedure and entails removing the irritation on the outside of the knee.
Post-operative rehabilitation is almost as important as the surgery itself, yet it is often one of the most neglected. Most patients find they experience the quickest and most successful results by following the guidance of an experienced sports medicine professional.
Dr Baba is a well-known and respected orthopaedic surgeon and sports medicine physician. If you think you may have an ITB injury, make an appointment to see him for a thorough assessment and diagnosis.
Image courtesy of bodyheal.com.au