Iliotibial band syndrome
With the warmer weather finally upon us, our activity levels tend to be on the rise, which sometimes leads to a higher incidence in training injuries or repetitive strains. One of those injuries I have come across as of late is Iliotibial band syndrome.
Iliotibial band syndrome results in pain on the outside of the knee which is caused by friction of the iliotibial band on the side of the knee. It is also known as ITB syndrome or ITBFS and sometimes referred to as runners knee (I believe I have also heard it called jumper’s knee as well, but do not quote me on this!).
Symptoms
Symptoms of ITB syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur or bony bit on the outside of the knee.
It comes on at a certain time into a run and gradually gets worse until often the runner has to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill.
Pain may be felt when bending and straightening the knee which may be made worse by pressing in at the side of the knee over the sore part. There might be tightness in the iliotibial band which runs down the outside of the thigh. Tender trigger points in the gluteal muscles or buttocks area may also be present.
Causes
Certain factors may make you more susceptible to developing runners knee or iliotibial band syndrome:
1)A naturally tight or wide IT band may make someone more susceptible to this injury.
2)Weak hip muscles, particularly the gluteus medusa are also thought to be a significant factor.
3)Over pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. Other factors include leg length difference, running on hills or on cambered roads.
Treatment
Below are a number of treatment options for ITB friction syndrome.
Rest
Rest is important to allow the inflamed tendon to heal. Continuing to run with ITB syndrome will most likely make it worse. Initially complete rest is a good idea but later activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.
Cryotherapy
Apply cold therapy or ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea to ensure the pain does not return. Once the inflammation has gone then potential causes must be addressed such as a tight ITB or the pain will most likely return.
Stretching exercises
Stretching exercises for the muscles on the outside of the hip in particular are important. The tensor fascia latae muscle is the muscle at the top of the IT band and if this is tight then it can cause the band to be tight increasing the friction on the side of the knee.
Foam roller exercises
Using a foam roller on the IT band and gluteal muscles can help stretch the iliotibial band and remove any tight knots or lumps in the tendon. therefore friction on the side of the knee. For more information on how to foam roll effectively and safely, please see Mistakes you may be making while foam rolling
Strengthening exercises
Improving the strength of the muscles on the outside of the hip which abduct the leg will help prevent the knee turning inwards when running or walking and therefore help reduce the friction on the ITB tendon at the knee. In particular strengthening exercises for the tensor fascia latae muscle and gluteus medius such as heel drops, clam exercise and hip abduction are important.
Sports massage
A professional therapist may perform sports massage to help relax and loosen the tissues and use myofascial release technique, such as Rolfing or fascial Stretch Therapy which have been shown to be highly effective.
A tight ITB can contribute to friction at the knee and sports massage is an excellent way of relieving the tension in the tendon.
The aim of sports massage is to release tension in the muscle and fascia and stimulate blood flow. Massage must not be performed during the acute stage of an injury – usually at least 48 hours after injury. For grade two and three strains, massage may not be suitable for over a week. This is because if there is still bleeding then heat and massage will increase bleeding, not stop it.
Training modification
Errors in training should be identified and corrected. These can include over training or increasing running mileage too quickly. As a general rule a runner should not increase mileage by more than 10% per week. Running across a slope or camber in the road for long periods or poor foot biomechanics should be considered. When training starts again avoid too much downhill running.
A rehabilitation strategy which includes stretches and exercises to strengthen the hip abductors is important.