Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) is an overuse syndrome that occurs often in runners, cyclists and athletes who perform repetitive movements of the knee. It is one of the most common injuries in distant runners and has had a lot of press online and in running magazines.

What are the signs and symptoms of ITBS?

An aching pain on the outer side of the knee is the most common symptom of iliotibial band syndrome and this is due to inflammation at the site where the band crosses back and forth across the outside of the thigh bone (femur).  The Iliotibial Band moves across the lateral condyle of the femur at around 30⁰ knee flexion and causes compression of the tendon during the foot-strike phase of running. There is normally a slow onset of symptoms related to activity levels.  This can progress until there is pain with walking and with stairs if symptoms are ignored.

What are the causes of ITBS

  • Errors in training e.g. running around track in same direction, too many miles, ignoring pain
  • Sudden changes in training intensity, terrain or footwear.
  • Poor lower limb biomechanics e.g. over-pronated foot position, knees turned in, increased Q angle, leg length difference, pelvic tilting
  • Poor pelvic, hip and core stability.
  • Muscle imbalances; particularly at the hip.
  • Excessively tight ITB.
  • Inappropriate footwear.

What can a Physiotherapist do to heal your ITBS?

  • Carry out a detailed assessment to exclude other possible causes of pain.
  • Educate and give advice regarding rest, activity modification, pain relief and ice as appropriate.
  • Guide patients back to their sport effectively as symptoms improve.
  • Address the causes of ITBS including exercises to address muscle imbalances.
  • Perform soft tissue massage or deep tissue massage to release the Iliotibial Band.
  • Refer to a podiatrist when appropriate for a biomechanical assessment.
  • Empower the patient with the knowledge and skills to self-manage and prevent further episodes.

Tips to avoid ITBS

  • Follow a graduated training programme. Research says about 10% increase in overall running load per week should be able to be tolerated by the body
  • Perform a walk/jog warm up and some gentle dynamic stretches before you run.
  • Stretch those hip flexors!!
  • Perform a simple bridge motion for glute strengthening.
  • Invest in a foam roller.

ITBS is a very common, preventable overuse injury. It is best to get early assessment and treatment to prevent longstanding problems.  “Prevention is better than the cure”.