Iliotibial Band Syndrome (ITBS)

 

What is it?

The Iliotibial band is a tough fibrous band of connective tissue that runs down the outside of the thigh and inserts into the outside part of the shin bone (tibia). It arises from the Tensor fasciae latae (TFL) muscle which is one of the muscles responsible for taking your leg out to the side (abduction). Running type activities involve a degree of hip side tilting motion and it is this muscle which helps to control the degree of movement which occurs. For a variety of reasons the iliotibial band can become irritated as it rubs over bony promiences of the thigh bone (femur). Iliotibial band syndrome occurs at the outside of the knee as the band rubs on the outside part of the femur (lateral epicondyle). This repetitive friction sets up a painful inflammatory response and results in gradually worsening lateral (outside) knee pain. Often the pain will abate when slowing to a walk only to come back with continued running. It is usually worse when running down hills or coming down steps.

Causes

Commonly ITBS commences whilst undertaking repetitive weight bearing type exercises which involve a certain amount of knee bending. Typically it is a running injury and usually comes about as a consequence of a change of either the amount of training i.e. the speed, intensity or distance, or the surfaces on which the training takes place i.e. hilly, uneven ground or running on banked surfaces or crowned roads which slope off to the side. Wearing inappropriate running footwear can also alter the normal mechanics of running and can impart additional stresses and strains on this area.
 

Biomechanical and anatomical differences involving foot posture, muscle lengths and joint stability issues can also predispose to this type of problem. For example, individuals with poor hip stability and gluteal strength may develop muscle imbalances which cause an overactivity and tightening of the muscles which join the ITB, increasing the likelihood of friction type conditions arising.
 

Treatment
 

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

• Ice and rest to reduce inflammation

• Taping to offload injured tissues to reduce further strain

• Electrotherapy to reduce pain and promote healing

• Acupuncture for pain relief, reduction of inflammation and restoration of normal muscle tone

• Soft tissue manipulation to restore normal muscle length and tone

• Addressing any anatomical malalignments with orthotics if required

• Correction of muscle imbalance issues which contribute to poor biomechanics

• Tailored and specific rehabilitation programme to address the causes of the dysfunction and prevent recurrence