Ilio-tibial band syndrome is a common overuse injury of the knee, generally associated with running. In this condition, pain is usually felt on the outside of the knee and it is often worse after a run or it can be painful during mid-run. The reported incidence is around 12% in runners and can result in many people stopping or interrupting their training.
It generally does not produce any adverse long term effects, although it can take a number of weeks to recover with a rehab programme. Usually the knee does not swell and certainly does not give way, or lock in position. However, this condition does not get better on its own, unless the underlying cause is addressed.
What is the IT band?
The ilio-tibial band is a thickening of strong non-elastic collagen fascia which runs from the pelvic bone down the outside of the thigh to the top of the shin bone. It is not actually a ‘Band’ and it is fixed all along the thigh bone.
How does it happen?
Ilio-tibial band friction syndrome is an overuse injury, caused by repetitive hip and knee movements such as running, especially downhill or on uneven surfaces. It is usually triggered by a sudden increase in training miles, training on hard surfaces, more hill work or a change in stride length due to fatigue. The over-activity of a small muscle (Tensor Fascia Latae/TFL) at the top of the hip can cause increased tension of the ITB, leading to knee pain.
The common cause is that the gluteal muscles are not doing their job properly, leading to overloading of the TFL muscle. This can also lead to the dropping of the hip and cause the leg to rotate inwards, while running. Tight hamstrings could also worsen this condition.
What should you do?
During the painful initial stages, you can reduce the inflammation by applying the principles of RICE (Rest, Ice, Compression and Elevation) to the affected area. Some runners report pain relief with acupuncture, dry needling and deep tissue massage to the TFL muscle.
However, it is important to correct the underlying biomechanical fault to avoid recurrence or aggravation of the condition. Use of an ITB band/brace or taping might be useful during the initial stages of return to running after the rehab process.
Below is a four week exercise programme to aid the recovery process and strengthen the hip muscles. There are two elements of the programme which are equally important.
- Improve the flexibility around the knee ( by stretches and foam roller)
- Improve the strength around the hip which controls the position of the knee
Hip Strengthening Exercises
Why? To improve dynamic hip strength and balance which are important to control your pelvis and knee while running. Exercises to improve hip control in single leg stance have been shown to help this condition.
Single Leg Dead-lift
- Stand on one leg and keep your back straight. Lean forwards from your hips and not from your back.
- Bend your knees slightly while letting the weights travel straight down. Keep this movement slow and controlled.
If you are doing this movement correctly, you should feel a pulling sensation in your hamstrings and gluteus muscles and nothing in your lower back.
Lateral (Side) Step-Up
- Lift leg and place foot on step/bench to side. Stand on step by straightening leg and pushing body upward.
- Step down, returning feet to original position. Avoid locking the knee and keep it in alignment with your second toe
Standing Band Hip Abduction
- Attach resistance band to a sturdy object then loop it around your ankle.
- Stand with your looped ankle behind the good leg.
- Slowly lift your foot and leg to the side, making sure to keep your toes pointed forward. Hold for 3 seconds, then return to starting position. Stand tall; don’t slump.
It is important not to roll over bony areas (like your knee). Always roll in line with the muscles and at a slow, controlled pace. Whenyou roll over a tight or painful area, decrease the speed and stay on top of this area for about 20 seconds, or until you feel the area release. Like deep tissue massage, it will be sore when you roll over areas of muscle tightness or trigger points. However, you will only need it for about 3- 5 minutes to reap the benefits.
When to do it?
It is best done after a workout followed by a static stretch of the muscle to improve muscle flexibility.
Stretching – Combined hamstrings and ITB
- Lying on mat, position towel under middle of the right foot with hands grasping towel on both ends.
- Raise right leg straight above, maintaining grip on towel with both hands. After you have reached your flexibility limit, gently pull it toward the left side while keeping the knee straight.
- You should feel the stretch in the hamstrings as well as the side of the right thigh. Hold it for 15 – 20 seconds. Repeat for 3 – 4 times
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Ilio-tibial band syndrome: an examination of the evidence behind a number of treatment options. Scandinavian Journal of Medicine and Science in Sports (2009).