Iliotibial Band Syndrome
Iliotibial band syndrome or, ITBS, is a prevalent injury among running athletes, particularly those athletes who run long distances. Among runners, it is one of the leading causes of lateral (outside) knee pain and considered one of the most common overuse injuries. While this ailment has a high occurrence among runners, ITBS can also be seen among soccer, basketball, field hockey, cyclists, and weightlifting athletes. Becoming familiar with common injuries can help with prevention and treatment options.
The iliotibial band (ITB) is a thick band of tissue (fascia) that originates at the iliac crest in the pelvis, runs down the lateral (outside) part of the thigh, and crosses the knee to insert into the top part of the tibia (shin bone). It forms from the tensor fascia lata (TFL) and two of the gluteal muscles (gluteus medius and gluteus minimus) in the buttock and then stretches across the knee. The iliotibial band (ITB) helps stabilize the outside part of the knee when it flexes and extends.
Mechanism of Injury
ITBS is an overuse injury that is caused when the portion of tissue near the knee that gets inflamed due to constant rubbing on the outside bony prominence known as the femoral condyle. During activities that cause the knee to bend (flexion) and lengthen (extension) is when the iliotibial band rubs against the femoral condyle and leads to outside knee pain.
Signs and symptoms of ITBS include;
- Sharp or burning pain that may subside when stopping activity.
- Pain that radiates up or down the leg.
- Inflammation (swelling) at the outside of the knee
- A feeling of a popping or snapping at the outside of the knee
While there is not one determining factor that may lead to ITBS, there are some predispositions that may lead to developing ITBS. Changes in training such as, increased training routine, hill running, changes in the surface you train on (grass to turf, track to road) can lead to increased risk. Anatomical risk factors include; increased iliotibial band (ITB) tightness, leg length discrepancy, weakness in the hip, knee flexors, and knee extensor muscles. Improper running technique can be a contributing component.
Athletes should have any injury reported to the Healthcare Professional covering their practice or games for an in depth evaluation. Treatment for ITBS is successful in most cases with conservative treatment. All athletes should give time for adequate rest when dealing with an overuse injury such as ITBS. While beginning a return to sport protocol, athletes should build back up slowly to the training regiment before the injury. Ice, compression, and elevation are helpful options when dealing with pain and inflammation at the knee. Proper warm-up and stretching before and after practice and contests can help increase flexibility in the lower extremities. Rehabilitative exercise to increase strength among the knee flexors (hamstring muscle group), knee extensors (quadricep muscle groups), hip adductors, as well as core stabilization will help with treatment as well as prevention of ITBS. In more serious and rare cases surgical options are available.
Ensuring proper running technique by making adjustments beforehand can help prevent problems in the future. Looking out for how your foot is striking the ground is a great start to instilling better mechanics. Most complaints from those who are dealing with ITBS is pain when the heel strikes the ground. Proper foot strike should begin with the forefoot, not a heel strike. The tempo of your pace is another aspect of technique to focus on, and should be around 180 strikes or stride per minute, and determines how long or short your stride is.
How are you positioned when running? Are you leaning on one side more than the other? Are you bent forward or leaning back? Try filming yourself and show it to a Healthcare Professional who is evaluating you and can help determine proper corrections. Proper fitted footwear can also make a difference, as opposed to last year's cleats or athletic shoes.
Iliotibial Band Syndrome (ITBS) is a common overuse injury that can cause lateral knee pain among athletes. It is preventable with proper footwear, running technique, and a gradual training regiment. Treatment with conservative methods and proper strengthening can bring most athletes back to their previous training level. It is important to recognize symptoms early and get evaluated in order to minimize the time missing from one’s sport.
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Noehren B, Schmitz A, Hempel R, et al. Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. Journal Of Orthopaedic & Sports Physical Therapy. March 2014: 44(3). 217-222