Iliotibial band (ITB) Friction syndrome is one of the most common causes of lateral (outside) knee pain that we see, especially in runners. It’s also probably one of the most frustrating problems both for myself and for the patient. It is largely an overuse injury due to the repetitive nature of activities such as running. It often starts out as a little ‘niggle’ however gradually worsens & worsens until it quite literally will stop you in your tracks.
The ITB is a band of connective tissue that spans the length of the outer thigh. It originates up at the hip from another structure called the TFL (tensor fascia lata) and inserts onto the tibia just below the knee. It plays a crucial role in stabilizing the outside of the knee during activity. ITB friction occurs when the ITB gets tight & inflamed (as a result of overuse) and begins to rub over the lateral femoral condyle on the outside of the knee joint producing acute, often sharp pain in this area.
Many of my patients ask WHY? There are some factors such as pronated feel, tight calves, poor pelvic stability, anterior hip inflexibility and poor lower limb control that can increase the likelihood of developing this problem. Other extrinsic factors such as footwear & training loads also need to be addressed and considered when looking into the management of this issue.
- Pain felt on the outside of the knee
- Tenderness over the outside of the knee
- Pain generally worsens with activities such as running, particularly downhills and downstairs
- In more severe cases there may be swelling and or crepitus (creaking) over the side of the knee
- Pain can extend up into the thigh along the length of the ITB
Often people suffering from ITB friction may be able to run a few hundred metres before the pain will kick in. It is not advisable to try and run through this pain, you will aggravate the tendon which can then take several days to settle down.
DIAGNOSIS: A skilled physiotherapist will be able to diagnose ITB friction from your clinical history and a thorough examination. There is usually no need for further investigation unless you do not improve with appropriate management.
TREATMENT & MANAGEMENT
Physiotherapy is a vital tool to manage ITB friction syndrome. In the initial stages rest from aggravating activities will be required to allow inflammation and pain to settle.
Physiotherapy treatment should involve a variety of the following:
- Soft tissue releases to tight structures such as the ITB, TFL, gluteus medius, lateral quadriceps and lateral hamstring. This should then be complemented with use of a foam roller at home on a daily basis
- Addressing bio-mechanical factors such as poor pelvic stability and anterior hip inflexibility
- Advice regarding exercise modification, footwear & training loads. Some elements within training sessions should also be looked at such as the direction of running if using a track, if you are repeatedly running the same bend you will be overloading one side more than the other which can result in overuse injuries such as this.
- Dry needling is an awesome way of releasing tight bands of muscle. Often with this problem I find these all around the outside of the hip and down the length of the thigh.
- Electrophysical therapy such as TENS to help with pain & inflammation.
- Icing & use of anti-inflammatory medication
With the correct treatment most people with ITB friction syndrome will make a full recovery, however rehabilitation can be a lengthy process in those patients who have had the condition for a while. In saying that it is so important that this problem is caught early. If you get on top of ITB issues in the first 48-72 hours you will drastically reduce the amount of time off running.
Can it be prevented? There are some exercises that I would advise runners do on a regular basis in an attempt to prevent excessive tightness of structures such as the ITB. Use of a foam roller is a great form of self massage, it’s a bit of a love / hate relationship but it is extremely effective. Hip flexor stretches, general pelvic stability exercises and bilateral calf strengthening are essential in the long term management plan. Chat to your physio if you want someone to go over such exercises more thoroughly.
Have a great week!