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Iliotibial Band Friction Syndrome

Updated: Jul 26, 2019

Iliotibial Band Friction Syndrome

Iliotibial band (ITB) friction syndrome is a common knee complaint experienced by avid runners, and is an overuse injury of the tendon that runs along the outside or lateral aspect of the thigh.

The ITB is a thick band of fascia (tissue) that begins at the iliac crest in the pelvis, runs down the outside (lateral) of the thigh, and crosses the knee to attach into the top part of the tibia or shinbone.

It forms from the tensor fascia latae and gluteus muscles and then stretches across the outside of the thigh, before inserting into the side of the knee. The ITB helps to stabilize the outer part of the knee through its range of flexion and extension movements.

When the knee is flexed (bent), the ITB is located behind the femoral epicondyle - a bony outcropping of the femur or thighbone at the knee joint. When the knee is extended the ITB moves forward across this condyle.

There is a fluid filled sac, called a bursa that helps the band glide smoothly across the condyle. When the band gets excessively tight it can rub against the bursa and the condyle causing increased friction, resulting in pain and inflammation along the outside of the knee, known as ITB friction syndrome.

Iliotibial band inflammation occurs most often in long-distance runners, cyclists, and other athletes who repeatedly squat. It arises as a result of a combination of issues, including poor training and recovery habits, poor muscle flexibility, and mechanical imbalances in the body, involving the low back, pelvis, hips, knees and ankle.

There can also be a genetic predisposition to the development of ITB syndrome. Anatomical issues can include differences in leg length, abnormal pelvic tilting, collapsing of the foot (pronation) or bowed legs (genu varum). These situations can cause the iliotibial band to become excessively tight, leading to increased friction and irritation when the band crosses back and forth across the femoral epicondyle during activity.

Symptoms of ITBFS can be one or more of the following:

· Pain on the outside of the knee

· There may be a sensation of stinging or needle-like pricks

· Pain every time the heel strikes the ground

· Can become disabling with pain when walking or when climbing up or down steps.

· Some patients may feel a snapping or popping sound at the knee

· There may be some swelling either where the band crosses the femoral epicondyle or below the knee where it attaches to the tibia

· Occasionally, the pain may radiate along the course of the ITB up to the outer side of the thigh to the hip and even in to the calf.

Quite often, onset of the pain will be at a certain point in a long distance run and/or when a hill or bank during the run is encountered.

ITBFS can be easily diagnosed by examination from a suitably qualified allied health professional and more often than not is successfully managed with a combination of soft tissue release, biomechanical assessment and realignment, joint mobilisation and physical therapy exercises.

Because ITBFS is a condition characterised by inflammation, a rest period from the aggravating activity is an important first step in the treatment plan. Once the pain has significantly reduced, passive and static stretching of the ITB can be introduced to decrease tension and increase flexibility, especially at the femoral epicondyle, where the ITB generates the most amount of friction.

Finally, exercises are prescribed to strengthen the identified weak muscles (usually gluteus medius and minimus) that contribute to biomechanical imbalances causing the overload. Surgery is very rarely needed unless conservative treatment has been unsuccessful over an extended period. Even in these cases corticosteroid injections can be suggested but are often unnecessary.

3 tips to avoid ITBFS can be:

· Change your running shoes regularly à pronation or flattening through the arch of the foot is one of the primary causes of ITBFS, as such ensuring you have adequate arch support is essential in preventing its development.

· Gradual training load. A lot of the time, ITBFS will become present after a rapid increase in training load over a short period. Avoid ITBFS by training smarter, not harder. Following a general 10% increase in mileage and distance per week, will allow the body ample time to adjust.

· Make time to stretch and release the ITB and surrounding muscles. An increase in tightness in the muscles that surround and attach to the ITB increase its tension. Releasing with a foam roller along the lateral quads, glutes, TFL and hamstrings, will go a long way to reducing that tension. Also stretching through the ITB, before and after exercise, will help to increase its flexibility, a key component in the treatment of ITBFS.

So that’s a brief overview of how iliotibial band friction syndrome can occur and how to avoid it. If you have questions or comments feel free to e-mail us at admin@cbdwellnesscentre.com.au and we will happily answer them for you.

If you suffer from pain through the outside of the knee, especially when running or climbing stairs, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.


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