Iliotibial band syndrome is inflammation of the Iliotibial band on the outside of the knee as it rubs against the outside of the knee joint. Symptoms include pain over the outside of the knee which will come on gradually over time getting progressively worse until running must stop. Typically the athlete will rest for a period of time until symptoms go only for them to return so far into a run when training resumes.
It is also known as ITB syndrome or ITBFS and sometimes referred to as runners knee. We explain the symptoms, causes and best treatment options to return you back to full fitness in the shortest possible time.
Symptoms of ITB syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur or bony bit on the outside of the knee.
It comes on at a certain time into a run and gradually gets worse until often the runner has to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill.
Pain may be felt when bending and straightening the knee which may be made worse by pressing in at the side of the knee over the sore part. There might be tightness in the iliotibial band which runs down the outside of the thigh. A therapist or trainer may use Ober's test to assess this. Weakness in hip abduction or moving the leg out sideways is another common sign. Tender trigger points in the gluteal muscles or buttocks area may also be present.
See more on assessment & diagnosis.
What is iliotibial band syndrome?
Iliotibial band friction syndrome occurs when the long tendon of the tensor fascia latae muscles which runs down the outside of the thigh to the knee (called the illiotibial band) rubs against the outside of the knee joint causing friction, pain and inflammation.
Certain factors may make you more susceptible to developing runners knee or iliotibial band syndrome. A naturally tight or wide IT band may make someone more susceptible to this injury. Weak hip muscles, particularly the gluteus medius are also thought to be a significant factor.
Over pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. Other factors include leg length difference, running on hills or on cambered roads.
IT band treatment
Treatment for ITB friction syndrome needs to combine a number of options. The main aim is to reduce pain and inflammation, then stretch and condition the muscles so the injury does not recur when returning to full fitness.
Rest is important to allow the inflamed tendon to heal. Continuing to run with ITB syndrome will most likely make it worse. Initially complete rest is a good idea but later activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.
Apply cold therapy or ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea to ensure the pain does not return. Once the inflammation has gone then potential causes must be addressed such as a tight ITB or the pain will most likely return.
Learn more about Cryotherapy.
A doctor may prescribe anti-inflammatory medication such as NSAID’s e.g. Ibuprofen. This is useful in the early acute stage to reduce pain and inflammation. Long term it is not likely to be of benefit, particularly if it is just being used to mask in injury and not as part of the treatment. Always check with a doctor before taking medication in case you have contraindications which mean they could cause harm, for example asthmatics should not take Ibuprofen.
A professional therapist may perform sports massage to help relax and loosen the tissues and use myofascial release techniques which have been shown to be highly effective. Self massage techniques can also be very helpful in correcting excessive ITB tightness, especially where access to a massage therapist on a regular basis is not possible.
See more on ITB massage.
Dry-needling techniques or acupuncture may be beneficial also. Acupuncture is performed by inserting needles of various lengths and diameters into specific points over the body and in this case around the knee joint. The needle is usually inserted, rotated and then either removed immediately or left in place for several minutes. It is thought to be beneficial in reduce chronic or long term pain.
Iliotibial band syndrome exercises
Exercises are an important part of any ITB rehab routine. Stretching, strengthening and foam roller exercises all play a part in recovery from ITB syndrome.
Stretching exercises for the muscles on the outside of the hip in particular are important. The tensor fascia latae muscle is the muscle at the top of the IT band and if this is tight then it can cause the band to be tight increasing the friction on the side of the knee.
See more on Iiliotibial band stretches.
Foam roller exercises
Using a foam roller on the IT band and gluteal muscles can help stretch the iliotibial band and remove any tight knots or lumps in the tendon. therefore friction on the side of the knee.
See more on foam foam roller exercises for this injury.
Improving the strength of the muscles on the outside of the hip which abduct the leg will help prevent the knee turning inwards when running or walking and therefore help reduce the friction on the ITB tendon at the knee. In particular strengthening exercises for the tensor fascia latae muscle and gluteus medius such as heel drops, clam exercise and hip abduction are important.
See more on strengthening exercises for this injury.
Errors in training should be identified and corrected. These can include over training or increasing running mileage too quickly. As a general rule a runner should not increase mileage by more than 10% per week. Running across a slope or camber in the road for long periods or poor foot biomechanics should be considered. When training starts again avoid too much downhill running.
A rehabilitation strategy which includes stretches and exercises to strengthen the hip abductors is important. In acute or prolonged cases a corticosteroid injection into the site of irritation may provide pain relief.