ITB Syndrome, A Common Cause of Knee Pain

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By Dr. Stefanie Yao
Published on March 17, 2014

What is Iliotibial Band Syndrome?

IT Band Syndrome, Knee PainIliotibial band (ITB) syndrome is a common cause of lateral knee pain, often it can be due to an overuse issue but can also be due to a combination of overuse repetitive issues along with the bodies imbalances in biomechanical factors. Because ITB syndrome is a common cause of lateral knee pain it can be seen in athletes and non-athletes but it is commonly seen more frequently in runners, walkers and bicyclists.

The iliotibial band is a fibrous band/ fascia which runs down the outside side of the pelvis over the hip and attaches into the lateral knee helping stabilize and move the knee joint. The excessive friction of the distal end of the iliotibial band which slides over the lateral femoral epicondyle of the knee joint with repetitive knee flexion and extension causes the ITB to become inflamed leading to pain. In addition the proximal end of the ITB can also be irritated and can refer pain to the hip. Rarely does ITB syndrome get so bad that it requires surgery, though it can be very bothersome.

ITB syndrome is usually a non-traumatic overuse injury caused by friction of the distal iliotibial band as it slides over the lateral femoral epicondyle during repetitive flexion and extension of the knee leading to either a bursitis over the lateral femoral epicondyle and/or inflammation of the ITB.

Though ITB syndrome does not affect all athletes there are some potential risk factors that can may attribute one to ITB syndrome. A pre-existing iliotibial band tightness, increased running/cycling mileage, amount of time spent walking/running, muscular weakness of knee extensors and flexors and hip abductors has been shown to be attributing causes which can aggravate and contribute to lateral knee pain and iliotibial band syndrome.

The primary complaint of those with ITB syndrome tend to be a diffuse pain over their lateral aspect of the knee. With time and continued activity the initial lateral achiness can progress to a more painful, sharp localized discomfort over the lateral femoral epicondyle or lateral tibial tubercle.

Pain may start after running or several minutes into a run or exercise activity. As the iliotibial band becomes irritated symptoms may begin earlier in an individuals exercise session and may require the individual to stop due to the discomfort. Pain and discomfort from ITB syndrome can be aggravated with running down hills, increased stride length, sitting for extended lengths of time and with the knee in a flexed position.

ITB Treatment Syndrome

Treatment for ITB syndrome includes activity modification, massage, stretching and strengthening of the affected limb. The initial goal of treatment should be to alleviate inflammation with the use of ice and anti-inflammatory medications. In addition activity modification is an important part of treatment especially activities which require repeated knee flexion and extension activities.

As the acute inflammation subsides and diminishes a stretching regimen which focuses on the ITB, hip flexors and plantar flexors. Once stretching can be performed without pain strengthening of the patients gluteus medius muscle should be initiated. Return to normal physical activities such as running should be gradual, starting out at a lite pace on level surfaces and running within the pain-free range with milage slowly increased. Most patients find improvements within 3 to 6 weeks of stretching and activity limitations. In addition to treatments with a healthcare practitioner, orthotics maybe required to to correct pronation, excessive rotation and or a presence of a leg-length discrepancy.

Other modalities a healthcare practitioner may use to aid in ITB treatments may also include the use of ice, heat, ultrasound, electrical stimulation to aid in reducing the inflammation and pain. If a course of conservative therapies fail, surgical intervention may be required.