What Is It?

Iliotibial band syndrome, or IT band syndrome (ITBS), is typically associated with a persistent pain in the outer part of the knee. It is commonly considered an overuse injury of the lateral knee that occurs primarily in runners, but anyone who is physically active may present with ITBS. IT band syndrome occurs equally in men and women, and it is an injury linked to activities in which you bend your knee repeatedly, such as running, cycling, hiking, and walking.

The IT band is a thick bunch of fibers that runs the length of the lateral upper leg, from your hip area to just below the knee. Alterations in flexibility, balance, motor control, strength, and biomechanics can cause the band to rub against the outside of the knee. The friction from rubbing can lead to pain and swelling.

IT band syndrome can start out as mild pain that may intensify if not treated, but the good news is that ITBS usually gets better with time and treatment.

Symptoms

Symptoms of IT band syndrome can vary slightly from person to person in intensity and how they appear.  The primary symptom is pain located on the outside of your knee, just above the joint. In the beginning stage, the pain might go away after your warm up, however, over time you might notice it gets worse as you exercise including persistent pain while you are participating in physical activity and a lingering pain when your activity is finished.

Symptoms include:

  • Aching, burning, or tenderness on the outside of your knee
  • Feeling a click, pop, or snap on the outside of your knee
  • Pain up and down your leg
  • Warmth and redness on the outside of your knee
  • Tenderness with pressure at the lateral side of the knee


Causes

Pain from IT band syndrome is thought to be a result of inflammation and irritation of the IT band due to the friction from of the IT band rubbing on the outside of the knee. It is also believed that compression of tissues and other structures, such as bursa, may contribute to the irritation and pain.

IT band syndrome can be caused by insufficient training preparations such as weakness, poor flexibility, poor health, dysfunctional balance, poor nutrition, and a lack of adequate recovery.

Lateral hip weakness and IT band tightness are dysfunctions that are commonly thought to be causes for ITBS, but this is not always the case. Differences in hip strength or tissue mobility from the affected side to the unaffected side can provide valuable information in determining whether weakness and tightness are the primary cause of the IT band syndrome.

Studies that assess lower extremity mechanics with running have mixed results, but running on unusual or unstable surfaces are associated with the increased potential for presentation of ITBS. Landing awkwardly when stepping, running, jumping, or other similar activities may lead to possible increases in IT band pain, but repetitive knee bending, especially when under a higher load, is the most commonly associated movement with IT band syndrome.

Treatment

IT band syndrome is most commonly diagnosed with an injury history report and physical examination. This may include examining your movement, flexibility, and a more focused evaluation of the knee to rule out any other potential knee injuries. Imaging may be performed to also rule out other possible injuries to the area.

Initial treatment for ITBS focuses on decreasing any inflammatory response and decreasing pain. This is achieved by protecting the structures that are affected by rest or activity modification, ice (or sometimes heat), and oral NSAID’s. NSAID’s can be a valuable part of the recovery process, but the research on the use of NSAID’s with IT band syndrome is limited and there is some debate in the use of anti-inflammatory measures and their effect in delaying healing connective tissue injuries. If needed, corticosteroid injections may also be an option to help with the inflammatory control.

There are several ways in which Precision Performance and Therapy can help you recover from IT band syndrome. They include:

  • Providing suggestions for warm-up and cool down
  • Establishing an appropriate stretching routine
  • Creating a strength and balance program to help improve dysfunction and decrease the potential for future pain onset
  • Equipment modification (ex. shoes)
  • Training modification
  • Biomechanics assessment and correction
  • Perform soft tissue mobilization and manual therapy treatment such as joint mobilization, massage, ASTYM, and/or dry needling

Stretching is used to help with mobility of the tissues surrounding and connected to the IT band. There is some debate as to the efficacy of stretching the IT band itself due to the stiff (which can actually be desirable) nature of fascial tissue, but stretches focused on the Tensor Fascia Latae, Gluteals, Quadriceps, Hamstrings, and Calves (among others) is beneficial. The stretching protocol that may demonstrate the most benefit varies from individual to individual.

Soft tissue and manual therapy treatments for ITBS are shown to be beneficial, although more evidence needs to be done to strengthen any support. Soft tissue treatment may focus on the IT band itself, but is often more beneficial when performed on any surrounding structures that may be dysfunctional and/or contributing to additional stress in the IT band. Soft tissue and manual therapy treatments with complementary strengthening and balance activities can be very helpful in the return to pain free activity.

Activities to improve motor control, balance, and strength will help return to normal activity and maintaining these activities can often keep you going in the future with less potential for injury.


Risk Factors and How to Address Them

  • Changes in Equipment – Using different equipment such as changes in shoes without a gradual or conscious transition can increase the possibility of injury. When making changes to equipment (different or new equipment), make sure to have the best equipment possible for your body and the activity that you are participating in. Use a gradual transition when making changes or adding new equipment to a routine.
  •  Poor Technique and Body Mechanics — Having poor biomechanics or technique (such as running mechanics) can make an individual more susceptible to injuries such as IT band syndrome. Making to spend time focusing on technique and mechanics along with having body mechanics assessed by a qualified professional can improve body mechanics and help decrease the potential for injury.

  • Running or Training on Poor Surfaces — Poor surfaces such as places with holes in the ground, rocks, or other uneven object, as well as, training on hard surfaces such concrete can increase the potential of developing IT band syndrome. Paying attention to the surface you are on when participating in physical activity choosing to use more appropriate surfaces or alternating between surfaces to allow for rest from more stressful surfaces can decrease the chances of injury.
  • Certain Individual Physical Characteristics — Individual characteristics such as bowed legs, arthritis in the lower extremities, leg length discrepancies,  foot mechanics (ex. flat feet), flexibility deficits, and weaknesses (ex. abs, glutes, or hip muscles).  Being aware of individual characteristics and making sure to adjust to have activity match each individual is important.

  • Lack of Joint Coordination or Poor Balance and Postural Motor Control – Poor coordination or postural stability can effect mechanics, strength, and activity performance. Having posture and body mechanics assessed by an appropriate professional to determine any interventions that can be performed to improve technique and mechanics.
     
  • Poor Nutrition and Hydration — poor nutrition and hydration can lead to poor performance during the activity. Making sure to maintain appropriate nutrition and hydration getting professional help when needed is important to maintain health when participating in physical activity.