Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) describes damage to the iliotibial band (ITB) where it crosses the outside of the knee. The iliotibial band is a long thick band of connective tissue (fascia) that runs down the outside of the hip, from the area of the hip and buttock, down to the bottom of the femur (thigh bone) and the top of the tibia (shin bone) on the outside of the leg. Every time you take a step, the ITB moves across a bony bump on the outside of the knee called the femoral condyle. This is the point at which the damage tends to occur from repetitive rubbing.

ITBS causes knee pain and is one of the most common causes of Runner’s Knee (patellofemoral pain syndrome), in which a tight ITB causes the patella (kneecap) to mistrack and move out of alignment, causing pain and damage to the knee joint.

The Cause

ITBS is considered to be an overuse injury, meaning that it tends to occur in activities involving the repetitive movement of the ITB that involve the bending of the knee, such as running. The painful symptoms develop as a result of friction from the ITB rubbing against the outside of the knee joint at the femoral condyle, causing damage and inflammation. This is exacerbated by:

• Having a tight iliotibial band
• Weakness at the hip and core muscles, especially the quadriceps and gluteus medius
• Flat feet (pronation)
• Abnormal foot biomechanics
• Differences in limb length
• Improper running technique
• Unsupportive sneakers and shoes
• Training on hills
• Restricted fibular glide during the foot dorsiflexion (when the toes point upwards)

The Symptoms

The primary symptom of ITBS is pain on the outside of the knee. Other symptoms can include:

• Tenderness or burning on the outside of the knee
• Swelling
• Pain on bending the knee 30 - 45 degrees
• Pain that radiates into the thigh or calves
• Pain that is alleviated by rest but may resume on activity

The Treatment

Treatment starts by reducing the painful symptoms and allowing the ITB to heal. Resting, ice and anti-inflammatories can help with the symptoms, and helps prevent the damage from worsening, which would otherwise mean a longer recovery time. Primary treatment then focuses on addressing your specific cause(s) of the ITBS to stop it from recurring in the future.

Our expert Podiatrists will carry out a thorough biomechanical assessment to identify the contributing causes to your ITBS. From here, a treatment plan will be made based on your results and findings. This may include:

• Orthotics - to help correct alignment issues at the feet and legs, and reduce the strain on the ITB
• Gait retraining to work on your running technique and reduce ITB strain
• Assessing footwear - to ensure it is helping and not hindering your recovery
• Strengthening weak muscles, especially the gluteal muscles
• Stretching tight muscles, especially the ITB itself where needed
• Modifying training techniques and training schedule, temporarily while the ITB heals
• Mobilisation, dry needling and/or massage to improve the range of motion and reduce tissue strain