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| ITB Friction Syndrome (Runner’s Knee) |
What is the iliotibial band (ITB)?
The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. It is a tendinous extension of the fascia covering the gluteus maximus and tensor fascia latae muscles proximally. The band is crucial to stabilising the knee during running, moving from behind the femur to the front during the gait cycle.
What is iliotibial band friction syndrome (ITBS)?
Iliotibial Band Syndrome is one of the leading causes of lateral knee pain in runners. The continual rubbing of the band over the bone, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed, or the band itself may suffer irritation.
What are the features of iliotibial band friction syndrome?
- Pain localised over lateral femoral condyle (outside of knee)
- Discomfort initially relieved by rest
- Pain may radiate toward the outside of the knee and upper shin
- Worse if a person continues to run
- Symptoms frequently develop during downhill running
- Tightness of the Iliotobial band
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Figure 1 Iliotibial band and Gluteal muscles |
Symptoms and Causes
Some of the factors that can contribute to this syndrome are genu varum (bow legs), pronation of the foot (flat feet), leg length discrepancy, inadequate stretching program and running on a crowned surface or downhill. |
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| Figure 2 Over pronation of the feet |
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Over the past few years an association with weak gluteus medius (hip) muscles has been found in many runners with ITB syndrome. If the hip abductors (gluteal muscles) are weak, then the ITB is being overworked.
Immediate Treatment
As with any injury or ailment, you should see your physiotherapist for diagnosis and treatment.
After noticing symptoms, the first task is controlling pain and inflammation. For these symptoms, RICE works well.
For a runner with acute ITBS, reduce weekly distance training to 50% for 2 weeks, and only run on flat ground. After that, slowly begin to build distance again.
Stretching is second in importance, to make sure that the iliotibial band does not become taut. See stretching programme below or discuss this with your physiotherapist, who will customise an exercise programme for you. See below for suggested stretching programme.
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Strengthen the proximal hip muscles to lessen the load on the ITB. Strengthening the core stabilising muscles of the trunk can play an important part in prevention of ITBS as well. For successful rehabilitation, it is essential to restore the flexibility of the Iiotibial band, and to restore the strength and flexibility of the hip and leg abductors muscles.
Some other Rehabilitation Options
- Deep-tissue massage may help break up scar tissue that forms
- Orthotics (if appropriate). You can book a separate podiatry assessment with our podiatrist if you like
- Ultrasound
- Choose the correct running shoes
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