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Iliotibial Band Friction Syndrome

Description:

The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the lateral (outside) tibia at Gerdy’s tubercle. The most common cause of lateral knee pain in runners is Iliotibial Band Friction Syndrome (ITBFS). With repetitive knee extension (straightening) and flexing (bending), the iliotibial band rubs against the outside of the knee. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running.

Common Signs & Symptoms:

  • Diffuse lateral knee pain and tenderness on the outside of the knee (just above the knee) that may extend up and down the thigh and leg,
  • Pain is greatest at the beginning of exercise bout and decreases once the athlete is warmed-up,
  • Pain also increases with hill and stair descent, and
  • Pain is most noticeable when the foot first contacts the ground as the knee begins to flex.

 

Causes:

  • Excessive friction between the iliotibial band and underlying bursa during repetitive knee bending and straightening activities, i.e. running,
  • Hill and stair running descent,
  • Excessive mileage and/or sudden increases in mileage,
  • Running on canted surfaces, i.e. roads,
  • Leg length discrepancy,
  • Excessive overpronation or insufficient pronation, and
  • High-arched feet, bow-legged knee alignment and/or tibial varum.

 

Preventative Measures:

  • Appropriate warm-up and stretch before exercise bouts,
  • Maintaining appropriate conditioning:
    • Knee and thigh muscle flexibility,
    • Muscular strength and endurance, and
    • Cardiovascular fitness.
  • Allow ample time for rest between runs,
  • Proper footwear and custom foot orthoses that allow for optimal amount of pronation, and
  • Run on uncanted surfaces, i.e. tracks, and avoid hill/stair descent if intolerable.

 

Management:

  • Reduction of inflammation using ice, nonsteroidal anti-inflammatory drugs (NSAIDS) and electrotherapeutic modalities,
  • Massage therapy to reduce excessive tightness in the ITB, and
  • Stretching of the ITB and lateral muscles of the hip.