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Iliotibial Band Syndrome: A real pain in the knee!

Updated: Aug 30, 2019

Iliotibial band syndrome (ITBS) is often felt as a pain on the lateral aspect (outside) of the knee. It is a classic overuse injury due to repetitive flexion and extension of the knee, although there are several other factors that can lead to ITBS. During ITBS the band of connective tissue becomes irritated and inflamed causing friction down the iliotibial band as it moves less freely within the fascia. This pain is often felt around the knee, especially on flexion as this puts stress and movement through the band, although can be painful throughout the IT band on palpation.

The Iliotibial Band, often referred to as the IT band, is a long piece of connective tissue that runs down the lateral aspect of the thigh from the hip to the tibia (Fig a). The IT band Originates from the Tensor Fascia Latae and Gluteus Maximus Muscles and allows Extension, abduction and lateral rotation of the hip. The IT band also plays a big role in lateral knee stabilisation.

Warning signs and Symptoms of Iliotibial Band Syndrome

  • Sharp Pain on the outside of the knee, especially in flexion of the knee

  • Persistent or worsening pain when continuing with repetitive knee use such as running and cycling.

  • Swelling on the lateral aspect of the knee

  • Instability of the affected knee.

  • Possible referred pain into the hip.

What Causes Iliotibial Band Syndrome?

  • Weak muscles in and around the hip/glutes

  • Running biomechanics/running technique – especially if knees and ankles roll in when running/cycling.

  • Weak Vastus medialis (inner quad) and adductor muscles.

  • Weak/poor foot arch control

  • Soft or worn out footwear

  • Sudden increase in training load

Although an overuse injury, if training load is managed properly repetitive flexion/extension of the knee shouldn’t cause pain if the factors above are not apparent.

How do we treat Iliotibial Band Syndrome at Pentons Performance Therapy?

As with all our treatments we start with a full assessment to fully diagnose the issue as well as to understand why the injury may have occurred in the first place. There are several factors and muscle groups that can lead to ITB pain so assessment and treatment can cover all areas around the hip, legs and lower back. Muscle testing is a large part of the assessment for ITBS, this includes running through a range of exercise to isolate and examine each individual muscle function.

Once the issue has been diagnosed and areas to work on found treatment consists of a lot of massage work, often focusing on the hips and glutes although this differs depending on the individual. There is a lot of debate around foam rolling and massaging directly onto the Iliotibial Band, it can be extremely painful, but does it help? Treatment is primarily focused on the muscles surrounding the IT band, personally we don’t advise the IT band as the level of pain can lead to increased tension through the body. With in clinic treatments we do spend a little time treating the band with hands and dry needling but only with each client’s comfort zones. We often use K-Taping to offload the tension around the knee which can alleviate the pain.

We then run through a detailed rehab/aftercare programme to focus on areas which may have caused the issue initially. Often ITBS is caused by weak muscles so strength and conditioning is the focus although again this differs from client to client. All of our treatments are aimed around keeping each athlete participating in their sport/exercise so complete rest is a last resort, keeping active with focused rehab is the best way to overcome ITBS.

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