Iliotibial band syndrome

Iliotibial band syndrome
Classification and external resources
ICD-10	M76.3
ICD-9	728.89
DiseasesDB	32612
eMedicine	pmr/61 sport/53

Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome^[1]) is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting (especially squats).

Definition

ITBS is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Symptoms

ITBS symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.

ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight—each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known, This may also happen when a child's or teenager's hip grows faster than the band, and it creates tightness over the hip and knee, therefore creating a popping and snapping over the hip or knee.

Sports activities to avoid while symptomatic

• Association Football
• Running
• Stair climbing or mountaineering
• Deadlifts or squats
• Court sports, such as tennis, basketball, or similar
• Martial arts, such as karate (especially where being bare foot emphasizes any symptoms being caused by leg/foot abnormalities)
• Bowling
• Skating
• Wrestling
• Slacklining
• Cycling
• Dancing
• Parkour
• Rowing
• Softball
• Gymnastics
• Kitesurfing
• Futsal

Causes

ITBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:

Training habits:

• Always running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Excessive up-hill and down-hill running
• In cycling, having the feet "toed-in" to an excessive angle
• Running up and down stairs
• Hiking long distances
• Rowing

Abnormalities in leg/feet anatomy:

• High or low arches
• Supination of the foot
• Excessive lower leg rotation due to over-pronation
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
  • Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.

Muscle imbalance:

• Weak hip abductor muscles
• Weak/non-firing multifidus muscle

Treatment

^[2] While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Using a foam roller to loosen the iliotibial band can help prevent and treat ITBS although the treatment itself can be very painful to some. Also, an ultrasound machine can be used around the area to relax it, followed by a machine that utilizes electrode stimulation to the area to further relax it. This can result in more comfort and/or a wider range of motion. Consulting with a doctor or referring to a registered physiotherapist, athletic trainer, or a massage therapist would be the best solutions. Custom foot orthotics may treat this condition by controlling the amount of inversion (medial rotation) of the foot and thus reducing rotation of the leg and knee (which creates friction of the iliotibial band against the outside of the knee).

A very effective way of off-loading the ITB and restoring VMO control/normal medial glide of the patella, is via "McConnell's Taping", or taping pulling the knee medially (inward). Tape from the bottom half of the patella, to under the knee over the patella tendon. When this is done firmly, they should notice it feels 'stronger' or 'less painful.'

Other treatments available for this injury use a compression wrap to mobilize the ITB where the tendon meets the knee. This is called an 'IT band compression wrap.'

In cases where a conservative approach has failed, a steroid injection into the area is usually helpful, and can be curative.

Severe, treatment-resistant cases may require surgery to mobilize the band.

See also

• Knee
• Knee pain
• Chondromalacia patellae
• Patellofemoral pain syndrome
• Plica syndrome

References

Further reading

• Martens, M., Libbrecht, P., Burssens, A. 1989. Surgical treatment of iliotibial band friction syndrome. Am J Sports Med, 17(5):651-654.

External links

• Iliotibial Band Syndrome at ITBSyndrome.com
• Iliotibial Band Syndrome at drpribut.com