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IT Band Syndrome

Definition:
Iliotibial band syndrome (ITBS) is caused by inflammation of a band of connective tissue at the point where it crosses the lateral (outside) part of the knee joint. The iliotibial band begins at the hipbone in the tensor fascia latae muscle, with attachments to three other thigh muscles. The thick sheath of fibrous tissue runs down the lateral side of the thigh, ending at the tibia (shinbone) below the knee where it has an insertion into a bony bump called the Gerdy tubercle. It also inserts into the patella (kneecap) and the biceps femoris tendon. The IT band works in conjunction with several thigh muscles to stabilize the outside of the knee joint.

A point of friction occurs where the band crosses the lateral epicondyle, a bony protuberance at the distal (far) end of the femur. Between the bone and the IT band is the lateral synovial recess, an extension of the knee joint capsule. When the IT band becomes thickened through inflammation, this area can become filled with fluid, causing swelling.

Causes:
Overuse of the knee joint can cause inflammation. Long distance runners are particularly susceptible to this injury because the angle most often formed by the knee when it is bending and straightening to run long distances is the angle at which the IT band passes back and forth over the lateral epicondyle.

Other causes might be:
  • Improper technique when running, cycling, playing tennis or other sports that include repetitive knee flexion and extension
  • A sudden increase in the distance being run
  • Running on an uneven surface, or only in one direction on a track
  • A naturally tight iliotibial band
  • Weakness in the muscles surrounding the IT band
  • Weakness in the hip abductors
  • Overpronation of the foot, although not everyone believes that this is a factor
  • Biomechanical factors such as a discrepancy in limb length
  • Adolescents going through a growth spurt
Symptoms:
  • Tenderness to the touch
  • Initial feeling of tightness developing into pain
  • Pain on movement of the knee and worse with continued movement, particularly when going up or down stairs
  • Pain felt at the outside of the knee
  • Pain better with rest
  • Swelling at the point of pain
  • A snapping, popping or clicking as the knee bends
  • Occasionally pain felt in the hip
Diagnosis:
Your doctor will perform a careful and thorough physical examination of the knee and hip to rule out other possible injuries or conditions. Tests, which might include the Oberís test, the Noble test, the Thomas test, and the Renee creak test, might be done to assess strength and flexibility.

The exam and tests, and your medical history, are usually enough for a diagnosis. MRI (magnetic resonance imaging) or ultrasound might be needed if the diagnosis is not clear, or if a fracture or a bone spur is suspected. A MRI might also be used if conservative treatment has failed to provide relief.

Treatment:
During the initial acute phase of inflammation, the goal is to reduce pain and swelling.
  • Ice, crushed and in a bag covered with a towel, should be applied to the lateral part of the knee for 15 minutes at a time, several times a day.
  • Activity should be reduced to a level that does not induce pain.
  • NSAIDs (non-steroidal anti-inflammatory drugs) may be taken, as can pain relieving medication.
  • Massage
Once the acute phase has passed and the inflammation has been reduced, stretching exercises may begin. These will focus on increasing the range of motion in the hips, particularly the hip abductors and adductors. Strengthening exercises will be gradually introduced. Your physiotherapist will develop and supervise your recovery program, teaching you exercises that you can eventually perform at home.

Most people can return to their previous level of activity within 6 weeks, provided that exercises and stretches do not cause any pain. Occasionally, however, the usual recovery regime does not resolve the problem, and surgery is needed to remove the small section of the IT band that passes over the lateral epicondyle. In this instance, a splint to keep the knee extended for a week is applied after surgery.

Exercises:
Only perform these exercises with the permission of your doctor or physiotherapist, and only if you are able to do them without experiencing any pain.
Stretch 1:
Lie on your side, propped up on your elbow, with the injured leg uppermost. Pull the foot of the injured leg backwards towards your buttocks. Cross the ankle of the uninjured leg over the knee of the injured leg and push downwards until a stretch is felt. Hold the stretch for 30 seconds.
Stretch 2:
Use a counter or desk for support. Bend at the waist over the support and bend the left knee. As you bend it, slide the right leg (keeping the knee straight) behind the left leg and away from the body, parallel to the support. Bend the upper body towards the sliding foot. Hold the stretch for 30 seconds. Switch legs and repeat exercise.
Stretch 3:
Sit on the ground with your legs straight out in front of you. Bend the injured leg, cross it over the uninjured leg and place the foot on the ground. Place your forearm over the knee of the injured leg and gently pull the leg as close to your chest as possible. Hold the stretch for 30 seconds.
Side leg lift:
Lie on your side against a wall, with the injured leg uppermost. Bend your uninjured leg in front of you for support. Keep the back of the injured leg and your buttocks against the wall. Keep your toes pointing down and slide your leg up the wall as far as it comfortably goes. Hold the stretch for 5-10 seconds then slide the leg down again. Repeat 20 times for 1 set. Gradually build up to 3 sets. Repeat the exercise with the other leg.

Prevention:
  • Warm up properly before exercising
  • Do exercises to strengthen the hip and thigh muscles, particularly the gluteus medius
  • Do exercises to stretch the IT band
  • Wear orthotics if you tend to overpronate your feet
  • Run on a level surface and, if using a track, alternate the direction of the run.