According to the Royal Australian College of General Practitioners, iliotibial band (ITB) syndrome is the second most common injury in runners.[1] Researchers have suggested that between 5-14% of runners will experience this condition.[2]
When diagnosed with ITB syndrome, one common sign is the thickening of the tissue running along the outer part of the thigh. This feels like a wide and flat band travelling between the outer knee and the hips.
Read on to understand what you should know about ITB syndrome; the risk factors, treatment options and expected recovery time.
What is ITB Syndrome?
Iliotibial band syndrome describes outer thigh and knee pain. The ITB is a long, thick fascia (tissue) that runs between the hip muscles and the outer femur (thighbone). Repetitive stress on the ITB causes it to tighten and rub against the surrounding structures.
What are the symptoms of ITB syndrome?
The primary symptom of ITB syndrome is pain on the outside of the upper leg. The pain is most commonly at the knee joint and feels like an aching or burning sensation. People may also experience hip pain.
Common symptoms of ITB syndrome
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Burning or aching pain on the outer part of the knee
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Clicking sensation when moving the knee
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Pain when climbing stairs
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Pain that extends to the outer part of the leg or thigh
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Swelling on the outside part of the knee
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Increase in pain when running, especially downhill
What causes ITB syndrome?
There is not one single cause of ITB syndrome, however, there are some common issues that may increase the risk. These include repetitive activities such as running or cycling, excessively flat feet, a lack of flexibility or hip muscle weakness.
Common causes of ITB syndrome
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Muscle imbalance or weakness of the butt muscles
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Downhill running
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Improper pacing of running activities
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Running on uneven surfaces
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Pushing too hard beyond your physical capacity during running or cycling.
Sports that increase the risk of ITB syndrome
Sports that rely on repetitive bending and straightening of the knee for an extended period of time can increase the risk of ITB syndrome.
Here is a list of the most common sports that can result in ITB syndrome:
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Long-distance running
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Cycling
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Football
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Soccer
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Tennis.
How is ITB syndrome diagnosed?
Having ITB syndrome can limit you from doing sports activities and affect your quality of life. Patients may suffer from painful knees by simply negotiating stairs and walking because of the pain and inflammation on the ITB. A clear diagnosis of ITB syndrome is important to ensure you get the best treatment available.
A complete assessment of your knee and other lower body structures is the key to diagnosing ITB syndrome. One of the most recommended solutions by Australian GPs is an assessment with a physiotherapist.
Physiotherapists are clinical experts in rehabilitation that can effectively diagnose musculoskeletal injuries such as ITB syndrome and help you return to normal function.
Your visit to a physiotherapist will start with a consultation. Your physiotherapist will do a simple mini-interview about your health status, activities and previous injuries to get a comprehensive background of your condition.
After taking your history, your physiotherapist will conduct a physical assessment and movement screens to determine the exact cause of your symptoms and rule out other conditions.
Your initial evaluation typically lasts for 30 to 60 minutes. Take this time to discuss all relevant information about your condition.
From here, your physiotherapist will give you the details of your treatment program.
This will include:
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Exercise and treatment programs
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Home exercise programs to support your recovery even at home
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Education and expert advice
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Recovery time and treatment goals.
How is ITB syndrome treated?
Having ITB syndrome can be painful and limit your overall mobility due to pain and discomfort around the knee. It can also prevent you from participating in sports which may lead to deconditioning.
Stretching, warm-ups and pain medications may work for a while but ignoring the root cause of your symptoms may result in more significant damage to the soft tissues around the ITB.
There are several options when it comes to treating ITB syndrome. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Physiotherapists often see many sports injuries like ITB syndrome and are experts in treating these kinds of conditions. After the evaluation, they will give a specific treatment plan based on your lifestyle and treatment goals.
Your treatment for ITB syndrome will focus on decreasing the pain, strengthening weak muscle groups and improving the range of motion in your knee.
Depending on the severity of your ITB syndrome, a physiotherapist may provide you with a combination of the following types of treatments:
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Manual Therapy - Hands-on techniques performed by your physiotherapist to increase your mobility and allow pain-free motion.
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Strengthening Exercises - Progressive strengthening exercises of the gluteal muscles to stabilise the hip and provide lesser stress on the ITB during movements.
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Therapeutic Exercises - Exercise techniques to improve joint and muscle biomechanics.
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Stretching Exercises - Stretching techniques to elongate the muscles that affect the ITB band and decrease stress around the area.
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Myofascial Release - Mobilisation of soft tissue and applying pressure to various trigger points around the leg and thigh to decrease pain.
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Shockwave Therapy - Sometimes used to stimulate healing of soft tissue and decrease pain.
A typical physiotherapy session with your local physio will last anywhere between 30-60 minutes, and it is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
After your initial evaluation, your physiotherapist will formulate a treatment plan specific to you to help you maximise your recovery and improve your condition.
Self-care for ITB syndrome
If you think you have ITB syndrome, here are the best things you can do and avoid.
Things to do:
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Rest
ITB syndrome is the result of chronic repetitive stress on the knee. It is best to rest and take time off from your usual activities such as sports for a couple of weeks.
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Use Cold Compress
Swelling and tenderness can be noticeable signs of ITB syndrome. Use a cold compress for 15 minutes to minimise the swelling and control inflammation.
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Stretching
Regularly stretch your lower body muscles, especially the glutes. This will effectively reduce your pain and decrease the stress on the ITB.
Things to avoid:
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Avoid high-intensity activities in the short-term
Avoid high-intensity activities that will aggravate your pain. Try to avoid stair negotiation or downhill walking for a couple of weeks to give proper time for your body to heal.
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Avoid walking or running on uneven surfaces.
Uneven surfaces cause a lot of pressure on the knee and tendons that surround it. Doing so may aggravate your pain and hinder your recovery.
Do I need a specialist or surgery?
Your GP may prescribe pain medications to help you manage the symptoms. In rare cases, surgery can be done by cutting a portion of the ITB that rubs against the outer part of the knee (femoral epicondyle). This is extremely rare and is only done when conservative management fails.
Diagnostic imaging is typically not required to make a diagnosis of ITB syndrome.
A good doctor will refer you to physiotherapy for proper management and improvement of your condition.
What is the recovery time / prognosis for ITB syndrome?
You can make a complete recovery from ITB syndrome within 4 to 8 weeks. The key to resolving this condition is firstly rest, and gradual reintroduction of your activities.
Physiotherapy allows you to recover faster and improve your overall outcome. Through physiotherapy, you will be able to increase and stabilise specific structures of your lower body to prevent future injuries.
Can ITB syndrome be prevented?
These tips can help you prevent ITB syndrome or accelerate your recovery if you already have it.
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Take your time to warm up - Proper warm-up can help activate muscles needed for your workout leading to a decreased risk of injury on the knee and muscle strain.
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Do stretching exercises – Stretching exercises elongate short and tight structures of your lower body, preventing excessive stress on the ITB and knee joint.
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Do strengthening exercises - ITB syndrome is associated with weak hip and glute muscles (hip abductors). Strengthening these muscle groups can effectively reduce your risk of having ITB syndrome.
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Pace your activity - Proper rest intervals are needed for your body to recover from all the stress that you’re putting it through. Long-distance runners and cyclists should allocate appropriate rest days in between their training and events.
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Running habits - Run on a flat surface to minimise the stress on the ITB. Additionally, alternate which side of the road you run to balance the tension and pressure on both legs.
Outlook and the main takeaways
ITB syndrome can be frustrating and limit your sports participation for a couple of weeks up to a couple of months. It causes pain and affects all aspects of your mobility. Don’t delay your treatment, book a physiotherapist near you and start your road to recovery as soon as possible.
Anatomy of the ITB
The Iliotibial tract is a broad and thick band of fascia on the outer aspect of the thigh extending from the iliac crest down to the knee.
It is composed of dense fibrous connective tissue from the tensor fasciae latae and gluteus maximus, which acts as external rotators of the hip.
The ITB extends toward the lateral femoral epicondyle and borders the knee cap (patella) on the outer part of the knee.
During bending of the knee, the ITB moves backward to the femoral epicondyle and moves in front during straightening of the knee. This movement causes excessive friction over time when you do long-distance running.
Inflammation and pain can occur with excessive stress on the ITB on the site of the femoral epicondyle or the outside part of the knee resulting in ITB syndrome.
