What is ITB Syndrome?
The iliotibial band (ITB) is a long, thick band of fascia (strong connective tissue) that runs from the pelvis down the outside of the leg into the outer part of the knee. It helps to support the hip and provide stability to the knee.
ITB syndrome is an overuse injury and is the most common cause of lateral knee pain in runners. ITB syndrome occurs by repetitive flexion and extension of the knee, resulting in friction of the ITB at its attachment across the knee joint.
Symptoms of ITB Syndrome
- Sharp pain and/or swelling above the outer side of the knee
- Lateral knee pain that is triggered by running or other sports that involve repetitive flexion and extension of the knee
- Symptoms start when you begin to exercise more, or when you ramp up your running distance e.g., when training for a marathon
- Pain that worsens with time, distance or intensity of running, and eases with rest (but might persist after activity)
- Pain when bending knee
Causes of ITB Syndrome
ITB syndrome is a repetitive strain injury, often caused by training and biomechanical errors that increase the friction of the ITB across the knee joint, especially when the knee is bent at a 30-degree angle (“impingement zone”).
This can be triggered by a range of underlying muscular imbalances, fatigue or ground impact issues, including:
- Changes in hip muscle function
- Foot arch weakness or less than optimal control
- Inefficient running technique
- Sudden changes to running load (e.g., increase in mileage, changes to running surfaces, footwear)
- Excessive downhill running or new sprint training
- Insufficient recovery
How is ITB Syndrome diagnosed?
ITB syndrome is a clinical diagnosis that can be made by your physiotherapist based on your history, symptoms and examination. A physiotherapist will look for signs of friction on the outer side of your knee and work with you to understand what triggers the pain to identify the initial cause of the concern. Diagnostic imaging is very rarely required.
How is ITB Syndrome treated?
A physiotherapist can work with you to ease the pain and inflammation as well as improve your strength and technique to reduce the risk of future occurrences.
Your treatment program will be tailored to your individual presentation but may include:
- Education on load management and pain relief techniques
- Manual therapy to normalise joint range and motion of the hip and the knee
- Exercises to improve your specific strength deficits and biomechanical errors. This might include strengthening the knee, hip and leg muscles to improve running economy
- Advice on warm up, cool down and training routines
- Exercises to improve proprioception (body position awareness), agility and balance
- Consideration of appropriate footwear
- Onward referral for rare cases if pain and inflammation is non-resolving (e.g., sports and exercise physician)
FAQs
What can I do to manage my symptoms?
A physiotherapist can help to manage your ITB syndrome and will tailor a plan specific to your needs and injury. They may advise you on specific hip or leg strengthening exercises or recommend that you modify your activities during your rehabilitation, to allow for pain and inflammation to settle. Some of this advice may include:
- Stretching the muscles on the side of the thigh and hip
- Strengthening the muscles of the hip and knee
- Trying activities and exercise that reduce “impact” e.g., swimming or walking
- Using ice after activity and anti-inflammatory medication (if it is necessary)
Regular stretching of the muscles around the hip, thigh and knee, especially before and after running, is highly recommended. Ensuring you have adequate rest and recovery periods in between running and replacing running shoes as needed to provide the most support for your body. Planning your runs to be on flat surfaces as much as possible is also ideal for even distribution of weight and tension when running.
How can I prepare for a physiotherapist appointment?
A physiotherapist will want to understand your area of concerns by discussing any factors that may contribute to your pain or immobility.
It is recommended that you note down any symptoms you are experiencing and when they began, your personal and family medical history, current medications, and any questions you might want to ask during your appointment.
What can I expect when seeing a physiotherapist?
A physiotherapist may conduct a physical examination of your area of concern, discuss your day-to-day activity and medical history, and prescribe a treatment plan for recovery.
When should I see a physiotherapist?
A physiotherapist can help you to reduce or manage pain and immobility throughout your body. If your concerns are impeding on your ability to participate in your regular activities, it may be time to see a physiotherapist.
The longer these concerns are left unattended, the harder they can be to treat down the track.