ITB Syndrome

Iliotibial Band (ITB) syndrome is a common knee injury and is the most common cause of lateral (outside) knee pain among athletes. The iliotibial band is a thick band of fascia that starts near the hip joint and extends down the outside of the thigh, to insert on the outside edge of the shin bone (tibia) just below the knee joint. The main symptom is lateral knee pain caused by inflammation of the iliotibial band near the bony prominence (lateral femoral epicondyle) on the outside of the knee. The condition usually affects athletes who are involved in sports that require continuous running or repetitive knee flexion and extension. This condition is, therefore, most common in long-distance runners and cyclists. ITB may also be observed in athletes who participate in volleyball, tennis, soccer, skiing, weightlifting, and aerobics.

Symptoms of ITB syndrome 

ITB syndrome primarily presents as diffuse pain over the lateral aspect of the knee. Often this pain is associated with running or activities that require repetitive knee flexion and extension. Early during the course of the injury the pain usually feels like a dull ache which resolves after physical activity. If not addressed early and correctly, the injury may progress to a debilitating sharp pain during less strenuous activities, such as walking. With this progression, the diffuse pain also becomes more localised to bony prominence of the lateral aspect of the knee, lateral femoral epicondyle.

Causes of ITB syndrome 

ITB syndrome is caused by friction of the distal aspect of the ITB as it slides back and forth over the bony prominence on the outside of the knee (lateral femoral epicondyle). This friction occurs around 30º of knee flexion and repetitive flexion and extension of the knee results irritation to the ITB. Some factors that may cause this irritation include:

• Excessive TFL tightness.
• Change in training conditions e.g. Increase in distance or frequency
• Weakness of the muscles that extend (quadriceps) and flex (hamstrings) the knee
• Weakness of hip abductors (Gluteals)
• Excessive foot pronation (flat feet)
• Poor footwear
• Running on hard and bank surfaces (i.e.; roads)

Once symptoms of ITB syndrome begin they can further aggravate by activities such as:

• Running on inclines or declines
• Climbing stairs
• Walking after sitting for long periods with the knee flexed

Conservative Treatment of ITB syndrome

After performing a detailed Biomechanical Assessment to identify any causative factors, a comprehensive treatment plan is developed specifically to each patient. The goal is to minimize the friction of the ITB as it slides over the lateral femoral epicondyle. Some of the treatment options may include:

• Activity Modification. An initial change to your exercise regime may be needed to avoid the condition getting worse. This may be a decrease in distance, education of speed, change in terrain or less frequency. The introduction of a low impact alternate activity may also be of benefit such as swimming.
• Ice or heat.  This condition may respond better to either heat or ice. Try heat prior to exercise and Ice afterwards.
• Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDS), like ibuprofen, naproxen,  or aspirin, will help with pain and swelling; as per GP instructions.
• Strengthening Commonly with ITB syndrome there will be a lack of gluteal muscle activation. This causes excessive rotation of the femur and contributes to the irritation of the distal ITB to the knee. A strengthening program is essential for the rehabilitation of ITB pain.
• Adequate footwear.  A footwear assessment can be beneficial to assess what shoe is suitable for you. Try to avoid wearing old worn out footwear.
• Orthotic Therapy. A custom orthotic device placed in your shoe can help address possible causative factors such as flat feet or high arch feet.
• Taping. Taping may be of benefit to some patients who suffer from ITB syndrome depending on the biomechanical cause of their pain.
• Prolotherapy / Injection therapy: Can be a useful conjunct treatment option to help ease the pain if conservative treatment has plateaued.

Prognosis of ITB syndrome (outlook) 

For most patients, improvements in symptoms often experienced within three to six weeks of starting a treatment program. However, these results are achieved only when the patient is compliant with performing conditioning exercises.