A common injury among distance runners, iliotibial band syndrome (ITBS) presents as pain along the outside of the knee. The iliotibial band, or IT band, is a bundle of thick fascia fibers that begins at your hip, runs along the outside of your leg, and ends at the top of your shin. When your IT band is too tight or injured by repetitive movement, it can cause pain and swelling in the knee. IT band syndrome is the result of a non-traumatic injury from the overuse of the IT band and an underlying weakness in surrounding muscles.
Causes of ITBS
Researchers are still uncertain about the exact cause of ITBS. It's possible that the pain is the result of direct friction from the IT band as it slides over the knee each time is bent and straightened. It's also possible that the IT band is causing abnormal compression of the tissues beneath it as it slides over the knee. Either way, it is the repetitive motion of bending and straightening the knee that is responsible for ITBS. Over time, this repetitive motion causes inflammation and pain of the tendons, bones, fluid-filled sacs, and tissues in the knee.
Who Does ITBS Affect?
While anyone can get IT band syndrome, it's most common with long-distance runners, cyclists, skiers, rowers, soccer players, and other athletes. It can also affect people who bend their knee repetitively for recreational sports, like hiking or walking, especially when going long distances. Sometimes, as part of their job, people may overuse their knee if their job requires repetitive flexion.
There are three circumstances that increase the odds of developing IT band syndrome: incorrect training techniques, training on the wrong surface, and specific physical conditions. Being aware of these circumstances and avoiding them may help prevent you from getting this type of repetitive injury.
It's important to use correct training techniques, for example:
- Remember to warm up and cool down before and after your training session.
- Be careful not to push yourself too hard or for too long, to the point of injury.
- Take the time to rest and recover in between your training sessions.
- Replace worn-out footwear with new and appropriate footwear.
It helps to run or train on the right surfaces, for example:
- Try to avoid running downhill because of the added strain to your knees.
- Most roads slope toward the curb, so alternate which sides of the road you run on to keep your hips even.
- Typically running tracks bank a little bit, so train on banked surfaces rather than flat ones.
Some specific physical conditions can exacerbate IT band syndrome, for example:
- If you have knee arthritis.
- If you have bowed legs.
- If you have one leg that's longer than the other.
- If you rotate your ankle or foot inward when you're running.
- If you rotate your entire leg inward when you're running.
- If you have weak hip muscles, glute muscles, or ab muscles.
Iliotibial Band Syndrome Symptoms
Typically, the major symptom of IT band syndrome is pain on the outside of one or both knees, at or above the joint. At first, the pain may lessen or disappear once you have warmed up. However, over time the pain often gets worse the more you exercise. ITBS knee pain is often more acute when the heel strikes the floor and can radiate to the calf or thigh. The pain may be worse when walking or running downhill, walking or running long distances, or going down a flight of stairs.
There are some other symptoms besides outer knee pain that can happen with IT band syndrome, such as:
- Tenderness, burning, or aching along the outer knee.
- Popping, clicking, or snapping along the outer knee.
- Pain spreading up or down the leg.
- Redness or warmth along the outer knee.
Your doctor can determine whether you have IT band syndrome based on your health history, a physical exam, and your symptoms. When the doctor does a physical exam of your knee, it typically includes testing your knee strength, knee stability, range of motion, and areas of knee tenderness. Your doctor can determine if your outer knee pain is from IT band syndrome or a different injury, like a tear in your meniscus or osteoarthritis. Although imaging tests aren't usually necessary, sometime you may need to get an X-ray or MRI to rule out other causes for your knee pain.
Common ITBS treatments
Once your doctor has diagnosed you with IT band syndrome, typically your doctor will give you directions on how to take basic steps for healing your IT Band. Often, the doctor will also suggest that you work with a physical therapist to ease the swelling and pain, strengthen your muscles, and learn how changes in your routine can prevent further injury. Usually, the doctor recommends following the basic steps and doing physical therapy for six weeks, but it could be longer or shorter depending on the severity of your IT band syndrome.
Some common steps for IT band syndrome treatment include:
- Stop doing activities that cause the pain in your knee.
- Reduce pain with other-the-counter pain relievers.
- Put an ice pack on your knee 15 minutes at a time to reduce swelling.
- Reduce swelling and pain with ultrasound or friction massage.
- Use appropriate footwear for support, including shoe inserts if necessary.
- Learn exercises to stretch and strengthen your IT Band and surrounding muscles.
- Adjust your training schedule, improve your form, and be gentler on your body.
- Get a cortisone injection, although this normally suggested only in severe cases.