Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners. It occurs when the iliotibial band, the ligament that runs down the outside of the thigh from the hip to the shin, is tight or inflamed. The IT band attaches to the knee and helps stabilize and move the joint.
When the IT band isn’t working properly, movement of the knee (and, therefore, running) becomes painful. IT band pain can be severe enough to completely sideline a runner for weeks, or even longer.
Identifying symptoms of ITBS
Because the most notable symptom is typically swelling and pain on the outside of the knee, many runners mistakenly think they have a knee injury.
The best way to tell if you have ITBS is to bend your knee at a 45-degree angle. If you have an IT band problem, you’ll feel pain on the outside of the knee.
Additionally, sometimes an MRI can confirm whether your injury can be diagnosed as ITBS. An X-ray will usually produce negative results, but an MRI can show a partial thickening of the band — which results from inflammation.
What causes iliotibial band syndrome?
Iliotibial band inflammation is an overuse syndrome that occurs often in long-distance runners, bicyclists, and other athletes who repeatedly squat.
The iliotibial band syndrome may be the result of a combination of issues from poor training habits and poor flexibility of muscle and other mechanical imbalances in the body, especially involving the low back, pelvis, hips, and knees.
Anatomy issues may include differences in the lengths of the legs (a leg-length discrepancy), an abnormal tilt to the pelvis, or bowed legs (genu varum).
These situations can cause the iliotibial band to become excessively tight, leading to increased friction when the band crosses back and forth across the femoral epicondyle during activity.
Training errors may cause runners to develop iliotibial band syndrome symptoms. Roads are canted or banked with the center of the road higher than the outside edge to allow for water runoff.
If a runner always runs on the same side of the road, it produces the same effect on the body as having a leg-length discrepancy. One leg is always downhill compared to the other, and the pelvis has to tilt to accommodate the activity.
Running too many hills can also cause inflammation of the IT band. Running downhill is especially stressful on the IT band as it works to stabilize the knee.
Bicyclists may develop IT band inflammation should they have improper posture on their bike and “toe in” when they pedal.
This can cause the same effect as bowed legs, increasing the angle of the IT band as it crosses the knee, increasing the risk of inflammation.
Other activities with increased knee flexion can cause symptoms and include rowing and weight lifting, especially with excessive squatting.
Prevention of ITBS
Here are some steps you can take to prevent iliotibial band syndrome:
- Most importantly, always decrease your mileage or take a few days off if you feel pain on the outside of your knee.
- Walk a quarter- to half-mile before you start your runs.
- Make sure your shoes aren’t worn along the outside of the sole. If they are, replace them.
- Run in the middle of the road where it’s flat. (To do this safely, you’ll need to find roads with little or no traffic and excellent visibility.)
- Don’t run on concrete surfaces.
- When running on a track, change directions repeatedly.
- Schedule an evaluation by a podiatrist to see if you need orthotics.
Treatment of ITBS
Once you notice ITB pain, the best way to get rid of it for good is to rest immediately. That means fewer miles, or no running at all. In the majority of runners, resting immediately will prevent pain from returning.
If you don’t give yourself a break from running, ITBS can become chronic.
While you’re backing off on your mileage, you can cross-train. Swimming, pool running, cycling, and rowing are all fine. Stair-climbing is not, because it is too much like running.
Side stretches will also help, as will ice or heat, ultrasound, or electrical stimulation with topical cortisone.
If your ITB problem doesn’t get better after several weeks, seek help from a sports-medicine professional.
You may need a cortisone injection to break up scar tissue and help speed healing. But cortisone presents its own risks, as it can weaken ligaments and tendons. Consider cortisone injections as a “second-to-last resort.”
Your last resort is surgery to release and mobilize the IT band.
How is iliotibial band syndrome diagnosed?
Often, the diagnosis of iliotibial band syndrome can be made by the patient’s story of symptoms. The patient describes the progression of lateral knee pain that is made worse when the heel strikes the ground.
Physical examination is helpful because the area of pain can often be palpated with tenderness and swelling felt over the femoral epicondyle where the bursa or sac is located.
The health-care professional may also look for leg-length discrepancy, muscle imbalance, and tightness in the legs and back.
There is tenderness of the outer thigh just above the knee joint while the knee and hip joints themselves are normal to examination.
Usually, a full physical examination of the low back and legs, including the hips, knees and ankles, is performed to detect other potential causes of outer knee pain.
Plain X-rays are not usually required to help with the diagnosis, but MRI may be used to look for inflammation surrounding and beneath the iliotibial band.
The MRI can also exclude other causes of outer knee pain. These include torn cartilage (lateral meniscus), sprained lateral collateral ligament, and tendon inflammation.