Iliotibial Band Syndrome Causes & Treatment

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What Is The Iliotibial Band?

Your iliotibial band is a thick band of connective tissue that runs down the outside of your thigh. If you rest your hands on the sides of your thighs, you’ll be touching the general region of the band, which starts at the outside of your hip and runs down to connect to the outside of your knee. This band plays a crucial role in stabilising both the hip and knee joints, making it vital for everyday movement and function.
 
Iliotibial band syndrome (ITBS) occurs when the iliotibial band repetitively rubs over a bony bump on the outside of the knee, called the femoral condyle, as the knee bends and straightens. This repetitive friction can cause pain, swelling, and discomfort on the outside of the knee and along the iliotibial band.
diagram indicating where the pain and inflammation would be with Iliotibial Band Syndrome

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What Causes ITBS & Who Is At Risk?

The causes of ITBS lie in the characteristics of the iliotibial band itself, the surrounding musculature and biomechanics, as well as the activities you engage in and the associated stress on the band. You may be at increased risk if you:

  • Engage in repetitive activities like running, cycling, or hiking, as these involve frequent bending and straightening of the knee, placing strain on the ITB.
  • Have a tight ITB, which may occur if stretching or foam rolling has been neglected. A tight band moves more forcefully over the femoral condyle, increasing the likelihood of irritation and damage.
  • Increase your running distance or intensity, as longer or more frequent sessions without adequate rest heighten the ITB’s vulnerability to overuse. Unsupportive footwear or biomechanical issues like flat feet can exacerbate this strain.
  • Have weak gluteal muscles, which can lead to overactivity in the tensor fascia latae muscle, adding tension to the ITB and contributing to its tightness.
  • Are recovering from a knee injury or surgery, where inactivity may weaken the surrounding structures, making them prone to strain once activity resumes.
  • Have inefficient foot and leg biomechanics, where misalignment or improper movement patterns in the feet and legs can create a chain reaction that places extra stress on the ITB.
  • Rely on unsupportive or worn-out footwear, which can fail to properly stabilise the feet and ankles, affecting leg biomechanics and increasing the workload on the ITB.

Proper assessment and management can help address these risk factors and prevent the onset or recurrence of ITBS

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Signs & Symptoms Of ITBS

The primary symptom of iliotibial band syndrome (ITBS) is pain on the outer side of the knee, which becomes more pronounced with physical activities that involve repetitive bending and straightening of the knee. The pain may develop gradually or suddenly and tends to worsen with continued activity. Additionally, the knee may feel stiff, weak, and exhibit some swelling.
 
If your pain is situated at the front of or below the kneecap, it is likely due to a different cause of knee pain rather than ITBS.

Treating & Preventing ITBS

Treatment and prevention of iliotibial band syndrome (ITBS) involves three key steps: relieving immediate pain, promoting healing of the damaged ITB and associated structures, and preventing recurrence of the condition. At Priority Podiatry Clinic, we address all three through:
  • Training schedule review: By analysing and adjusting your gait patterns and training routine, we help minimise contributing factors to ITBS.
  • Custom foot orthotics: These address biomechanical issues in the feet and legs that may exacerbate ITBS.
  • Footwear assessment: Ensuring your shoes support healthy biomechanics and reduce undue strain.
  • Physical therapy: Targeted exercises to strengthen weak muscles, such as the glutes, and stretch tight areas like the ITB.
  • Hands-on treatment: Techniques such as mobilisation and dry needling to directly relieve tension in the muscles.

 

For initial pain management, we recommend applying ice (indirectly, for no more than 20 minutes every 1-2 hours), using non-steroidal anti-inflammatories, resting the affected leg, and avoiding movements that trigger pain.

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