Iliotibial Band Syndrome (ITBS) is an injury that commonly affects runners and cyclists, or athletes with repetitive motion of the knee. More and more, I am seeing this in people who do not undertake these activities regularly. It occurs when repetitive motion causes excessive friction between the lateral epicondyle of the knee and the iliotibial band (ITB). When the knee is positioned in extension, the ITB lies anteriorly to the lateral femoral condyle, when the knee is flexed 30 degrees.
ITBS is an overuse injury, often associated with weak hip abductors. ITBS is the most common injury of the lateral knee in runners with an incidence rate of up to 12%. It has even been reported to account for 22% of all lower limb injuries, but as mentioned, this is now presenting in more and more people because of how bad our lower limb posture has ecome. Therefore we are creating these same movement patterns through daily activities.
The ITB arises from the lateral border of the iliac crest (side of the pelvis), descends vertically down the lateral aspect of the thigh, becoming denser at its distal portion. It attaches at Gerdy’s tubercle and the lateral proximal aspect of the fibular head, with an expansion to the lateral border of the patella. It is composed of dense fibrous connective tissue that appears from the Tensor Fascia Latae (TFL) muscle, the Gluteal Fascia and the Gluteus Maximus muscle. This can cause the ITB to be stretched when contracted.
Clinical Presentation and Examination
Patients with ITBS will perceive pain on the outside of their knee, over or slightly below the lateral femoral epicondyle. They will report repetitive activities involving knee flexion and extension, such as running or walking or when climbing stairs. They may also report a burning pain when pressure is applied to the area during knee movement. Pain is activity induced and can increase with intensity of movements. A thorough physical examination is key to help diagnose patients with ITBS.
Your Physiotherapist or Exercise Physiologist will provide education on activity and load modification, to help decrease aggravating factors. However it is not necessary to completely cease physical activity. Physiotherapists will also provide a stretching program to lengthen the fascia and muscles, particularly the TFL, gluteus medius and gluteus maximus. A foam roller may also be prescribed for the patient to use at home to aid this stretching program. Hands on manual therapy techniques may also be used, such as myofascial release and trigger point therapy. Strengthening exercises will be added to strengthen and stabilise the hip during activity.
The great news is that this can be addressed to ensure the problem does not recur. This whole process is about creating correct biomechanical and postural alignment. If you believe that you are suffering from ITBS injury, be sure to book an appointment with Optimum Health Solutions by calling us at (02) 8599 6275.