Article by John Miller
What is ITB Syndrome?
ITB Syndrome (Iliotibial friction syndrome) is one of the most common causes of "Runner's Knee" and can account for up to 22% of overuse injuries in runners. Being an overuse injury, it is caused by repeated trauma rather than a specific incident.
The ITB attaches to a bony protuberance (femoral condyle) on the outside of the knee. It slides forwards and backwards across this bony point with movement. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which commonly happens just as your foot strikes the ground in running. This region of 30 degrees of knee flexion is called an “Impingement Zone” or pinching of irritated structures over the outside of the knee, thereby producing ITB Friction Syndrome.
What is the Iliotibial Band?
The ITB, or iliotibial band, is a long, thin band of fascia that runs down the outside of your thigh. At the top of your thigh it is attached to your Tensor Fascia Latae (TFL) muscle, and Gluteus Maximus and at the bottom it attaches to your tibia (lower leg bone) and femoral condyle on lower outside portion of the thigh bone.
What Causes ITB Syndrome?
Essentially ITB friction syndrome is caused by altered running biomechanics due to underlying muscular imbalances.Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.
The most common causes include:
What are the Symptoms of ITB Syndrome?
There are varying degrees of severity of ITB Friction Syndrome. The most common symptoms include:
How is ITB Syndrome Diagnosed?
On examination, your physiotherapist or sports doctor will look for signs of ITB Friction Syndrome. The important diagnosis is discovering “what is causing” the problem. If this isn’t determined ITB friction syndrome will persist on a return to running. With a thorough assessment, further investigations, such as scans are not required.
ITB Syndrome Treatment
Many patients with ITB Friction Syndrome start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
In severe cases, some patients choose to undergo a surgical release of the iliotibial band which is called a Z-lengthening procedure. It entails removal of the irritating piece of structure that overlies the femoral condyle on the outside of the knee. This is a last resort as most cases respond well to conservative treatment or physiotherapy.
Post-operative rehabilitation is one of the most important, yet too often neglected, aspects of surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity.
For more information, please ask the advice of your physiotherapist.
ITB Treatment Options
ITB stretches are difficult to perform and often have minimal impact. ITB rollers are an excellent method to normalise your ITB length.
FAQs about ITB Syndrome
Helpful Products for ITB Syndrome
Common Sources of Knee Pain
Knee Ligament Injuries
Children's Knee Conditions
Other Knee-Related Conditions
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