Illiotibial Band Friction syndrome (ITB Syndrome): Runner’s Knee – Physiotherapy can help!

Knee pain?
Hip pain?
You might be suffering from Illiotibial Band (ITB) syndrome. Let me unpack what this means, and more importantly, what to do about it.
In order to understand the problem of ITB syndrome, we first need to understand the anatomy involved with the condition.

What is the Iliotibial band?

The ITB is a thin band of tissue or fascia that connects from the gluteus maximus muscle and the tensor fascia latae muscle (TFL) to the lower leg bone (tibia). The gluteus maximus muscle is the major muscle of the buttocks and is responsible for extending your leg behind you, as well as helping with movements such as standing from a sitting position. The TFL is located at the side of the hips and is responsible for helping to bring the leg out to the side of the body as well as flexing the hip or bringing the leg forwards away from the body as it does during walking or running.
The ITB is wider closer to the hips and becomes narrower as it reaches the knee and has to wrap around the outer part of the knee over bone before it attaches to the tibia. With the constant and repetitive nature of bending and extending the knee during running and walking, the IT band is always moving against the bony prominences of the knee. This normally doesn’t present much of an issue, however with altered biomechanics; the IT band is placed under greater strain and can become inflamed.

What is ITB Syndrome?

As described above, the ITB is in an area that is always moving over bony surfaces, if there are altered mechanics during running or walking this can cause increased friction or pinching of the ITB over this area. This increase in friction or pinching of the band is what causes pain.

What are the symptoms of ITB Syndrome?

– sharp pain with early ranges of bending the knee, or what is known as a painful arc
– pain located on the outside of the knee
– feeling of tightness along the outside length of the leg
– pain increases with activity

What causes ITB Syndrome?

There are many ways in which altered biomechanics can be caused during running. Many would automatically think there is something wrong with knee itself; however problems often start in the musculature above or below the knee.
Some common structures at fault include:
– weakened muscles in the hips, the gluteal muscles
– weakened muscles in the upper legs, often some of the quadriceps, which extend the knee
– flat feet which may require orthotics
– old worn out running shoes, or improper footwear
– too quick of a progression in long distance running
– tight muscles in the inner thigh which help to rotate the leg inwards

I think I have ITB Syndrome, what are my next steps?

There are many possible causes leading you to develop ITB Syndrome, assessment from a physiotherapist can help determine which structures are to be implicated and then be properly addressed. Often, a program to address the muscle imbalances that may be causing the pain can remedy the symptoms quickly. Without working on the causal factor, the pain will persist for much longer than with treatment. Seek treatment and advice so you back to your activity as soon as possible!
Travis Goettl
Travis is a Physiotherapy Student at the University of Toronto, completing an internship at ALPHA Health Services.

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