Everything a runner needs to know about Iliotibial Band Syndrome

Iliotibial Band (IT Band) Syndrome is a frustrating source of knee and hip pain for athletes, and is one of the most common causes of lateral knee pain in runners. Knowing what IT Band Syndrome is and how to prevent and treat it can help keep you running and not sitting on the side of the road

SYMPTOMS OF ILIOTIBIAL BAND SYNDROME

What are the symptoms of iliotibial band syndrome?

Iliotibial Band Syndrome and iliotibial band pain can present in several different ways. The most common presentation or complaint is pain at the outside part of the knee. This knee pain often is worse when bending or extending the knee, or during activities such as running or cycling. Usually the pain from a developing Iliotibial Band Syndrome is gradual and intermittent in the initial onset and then becomes more painful, more frequent and more consistent as the irritation and inflammation to the iliotibial band worsens.

Often the pain from IT Band Syndrome  may have a gradual onset during running or cycling or other athletic activities, but then the pain may improve and diminish once the exercise is stopped. In other cases, the pain from iliotibial band syndrome can become progressive and significantly  more severe as more inflammation develops the initial phase of iliotibial band syndrome.

In the more chronic cases of IT Band syndrome, the pain may be present even with daily activities such as walking, or sitting for a prolonged period of time, or walking up and down stairs.

You may also notice areas either around the knee or the lateral hip that are tender to touch. In some cases where the Iliotibial  Band is inflamed or irritated over the greater trochanter of the hip, sleeping  on the affected side may become uncomfortable and painful.

Typically, there is not much swelling in the knee with iliotibial band syndrome. If you are noticing a significant amount of swelling in and around the knee, it is important to see your physician to get a proper evaluation. Other orthopedic conditions may be present such as a torn lateral meniscus (part of the knee cartilage) and may require different treatment and intervention in order to get you back to your sport or activity.

ANATOMY OF THE ILIOTIBIAL BAND

What is the Iliotibial band?

The iliotibial band is a thick layer of fascial tissue along the outer part of the leg that runs from the hip to the knee.

Fascial tissue is a type of connective tissue that is mostly made up of collagen. Fascial tissue’s primarily encloses, stabilizes and surrounds muscles, blood vessels, nerves and internal organs.

Fascia is part of the body’s connective tissue which surrounds not only your muscles, but other structures in the body such as nerves, blood vessels, bones and even your internal organs. Its an often-ignored part of the body’s anatomy, even in medical school, but plays a vital role in the striation and function of the body.

Think of the fascial system as a three-dimensional system that helps maintain the structure, support and form of muscles (the fascial version of a girdle or control-top pantyhose). Fascia tissue provides for the transfer of tension and contraction from one muscle group to another and even provides the necessary structure and scaffolding for tissue repair after an injury.

The hip portion of the iliotibial band begins from the upper edge of the pelvic bone. Muscular attachments from the muscle in the front part of the hip called the tensor fascia lata and in the back from the larger muscles of the buttocks, the gluteus medius and gluteus minor insert to the front and back of the upper part of the iliotibial band

Anatomical studies have shown that the top of the iliotibial band attaches to the femur just below the greater trochanter and the lower part of the iliotibial band attaches to the outside part of the knee lateral femoral condyle and lateral tibia.

Causes of iliotibial band sydrome

There’s still some controversy on the “true” cause of iliotibial band syndrome and debate about whether muscle weakness found in runners with iliotibial band syndrome and lateral knee pain caused the iliotibal band pain, or did the pain at the IT band end up causing the weakness in the hip muscles.

We do know that weakness in the muscles around the hip and buttocks (gluteus muscles) can cause excessive hip and leg rotation during running, resulting in increased stress on the iliotibial band and the perception of tightness in the iliotibial band. Other factors that are believed to contribute to  IT band syndrome include running on a sloped surface such as the beach or road and excessive pronation or rolling in of the foot.In our experience, most cases of iliotibial band syndrome develop after an increase in running mileage or due to poor biomechanics and underlying muscle imbalances.

Iliotibial band syndrome may be the most common cause of lateral knee pain in runners with some sports medicine researchers reporting the incidence of iliotibial band syndrome in excess of 22% of lower leg injuries  in runners. The sometimes severe knee pain can limit your running and even walking in some cases.

One of the first things I try to figure out with patients suffering from Iliotibial Band Syndrome is exactly how long they have had the condition and if there were any previous injuries that may have predisposed them to developing their iliotibial band problems  in the first place.

For many athletes, there is a prior injury that changes their biomechanics; running gait, cycling position, etc, that then places extra stress and strain on the lower leg and leads to the development of Iliotibial band syndrome.

In some cases, there may be another preceding injury such as an ankle sprain, a low back injury or another injury that changes their running form just enough to lead to another injury.

In other cases, its simply a case of too much, too soon and overtraining.

Or, as I like to think of it, under recovery from their run training.

(Read about the other three mistakes all runners make that can lead to running injuries.)

The reality is that the cause of your iliotibial band pain can be fairly complex, meaning that the pain your feeling is most likely due to muscle imbalances in the hip and back rather than simply a knee problem.

How can I prevent getting Iliotibial Band Syndrome?

Prevention of Iliotibial band syndrome starts with improving strength in the hip and pelvis, avoiding excessive overtraining, allowing for adequate recovery and rest, following a regular stretching and strengthening program and selecting proper running shoes for your running style.

Sure it sounds like a lot, but we have a step-by-step approach that has helped hundreds of fellow runners.

What are the best initial treatments for Iliotibial Band Syndrome?

Initial treatment for the pain from iliotibial band syndrome can start with an ice massage to the painful area for 10 to 15 minutes after workouts when the pain first starts. For acute injuries (less than 2 weeks) anti-inflammatory medications such as ibuprofen (Motrin or Advil) or naproxen (Aleve or Naprosyn) can help with pain and irritation.

In chronic injuries there is less inflammation of the iliotibial band fascial tissue, therefor acetaminophen (Tylenol) may be more appropriate that the anti-inflammatory medications when dealing with the pain.

What about using a foam roller to fix my IT Band?

A foam roller is a great tool to break up scar tissue and help with myofascial release of the leg and thigh. However, remember that that ilotibial band is fascial tissue and is not prone to stretching.

Let me repeat that… you really can not stretch the iliotibial band. If you’ve ever tried to foam roll your IT Band, you probably remember how painfully the experience was.

So the focus of the foam rolling should be on the muscles that attach to the iliotibial band like the the lateral quadriceps (vastus lateralis), the lateral hamstrings of thigh (biceps femoris) and the gluteal muscles of the hip.

What if my knee pain isn’t from IT Band Syndrome?

What if you feel that your symptoms don’t entirely match our description of iliotibial band syndrome? In other words, what else could be causing your knee pain?

There are a long list of possible causes of knee pain and if you’re not clear on the cause, then have a sports medicine professional evaluation your knee and determine the correct diagnosis. As you can see below, the potential different diagnosis of pain to the outside part of the knee where the iliotibial band is location is quite lengthy.

Possible other causes of pain to the outside (lateral) part of the knee

• • Lateral meniscus injury
  • Lateral collateral ligament injury
  • Osteoarthritis
  • Tendonitis of the popliteus tendon
  • Tendonitis of the lateral hamstring (biceps femoris) or lateral calf (gastrocnemius)
  • Referred pain from sciatic nerve and lumbar disc herniation
  • Referred pain from peroneal nerve
  • Osteochondritis Dessicans of the lateral femur
  • Patellofemoral Syndrome

What are some IT Band Syndrome stretches?

Stretching of the muscles of the lateral hip (gluteus and tensor fascia lata) that attach to the iliotibial band is an important component of proper rehabilitation if these muscles are tight. Tightness of these muscles can increase the tension across the iliotibial band fascia and create increased friction under the iliotibial band at the knee.

One simple stretch is to stand and cross your injured leg behind your uninjured leg and bend over to touch your toes. A more advanced version of this exercise is to then extend the arms overhead and slowly reach to the opposite side (for the right IT band, extend the arms to the left) and then continue the stretch as the arms reach for the floor. As you perform this exercise, you should feel the stretch in the side and back on the hip. If you experience pain or muscle spasm then reduce the motion during the stretch.

The Cross-over Iliotibial Band Stretch

The seated cross-over Iliotibial band stretch is performed while sitting on the floor with the legs out straight. Bending at the hip and knee, take the injured leg and cross it over the uninjured leg. Twist the upper body towards the injured side to continue the stretch. An alternative method is to slowly extend the knee and leg of the tight IT band to increase the stretch.

The Figure-4 IT Band Stretch

The “Figure-4′ stretch is an exercise that can be done while seated at a desk and one of our favorite exercises for helping with iliotibial band pain.

While seated, cross the ankle of the injured leg on top of the opposite knee.  The stretch can be extended by either lightly pushing the flexed knee down towards the floor or by leaning forward at the waist and allowing your body weight to increase the stretch. Hold the stretch for 5 to 10 seconds and then slowly relax.

How can I do massage or trigger point release of the iliotibial band?

You can’t really massage the iliotibial band or do trigger point release on it, but you can do massage and trigger point release on the muscles that attach to the IT Band which would include the gluteus medius and the tensor fascia lata.

Gluteal Medius Myofascial Release