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Ilio-tibial Band (ITB) Friction Syndrome

Ilio-tibial Band (ITB) Friction Syndrome

Continuously inflamed or sore knees can be an indication of a problem with a group of connective tissues, muscles and tendons called the Iliotibial band, which runs down the outside of the thigh and connects to the knee.

Many sports-science clinics see this type of injury: it is most common in athletic activities that require repetitious and forceful physical exertion that impacts on the knees, such as gymnastics, motocross, cycling, squash, ballet or running, although backpacking, skateboarding, orienteering, and frequent hikes can also be the cause of sore knees.

What Is an Iliotibial Band?

The Iliotibial band (ITB) acts like a finely tuned tensioned pulley system in the leg: the connective tissue has the qualities of a tendon in some places and of a ligament in others. The gluteal muscles and the tensor fascia lata muscle attach to the hip and glide down the outer thigh to attach to the tibia, which is under the knee.

Essentially, the entire mechanism consists of a group of hip muscles at the top of the thigh that connect to the ligaments in the knee. They perform the function of stabilising the body, much like the stabiliser wheels on a child’s bicycle. When this group of muscles rubs continuously over a protruding bone called the lateral epicondyle located on the side of the knee, the pulley system retracts and tightens with over-use, and pain ensues.

IT band syndrome (ITBS) is thought to be a form of tendonitis, or an inflamed tendon. It is the result of a sports activity that causes the leg to turn inward repeatedly. Repetitive activity causes friction as the ligament rubs against the bone, and so it is commonly known as iliotibial band friction syndrome (ITBFS).

Sports-specific injury

While IT band syndrome is common in marathon runners, it is also found in motocross competitors and cyclists, whose repetitive and impactful movements on uneven ground are the cause of injuries affecting the front and the side of the knees.

Some runners make the mistake of running the same path every day or repeating the same pattern of movements on the same side of the road, not realising that the uneven slope of the road causes the musculature on one side of their body to over-compensate for the other. Running on a slope means that one foot is always lower than the other and so an imbalance causes the pelvis to tilt, leading to ITBFS.

Cyclists who practise on a resistance trainer are trying to get an intense workout in the shortest time possible, which is repetitive and monotonous and can lead to ITBFS. Low-resistance spinning would be better.

Knee pain

The sore knee that is associated with IT band syndrome is often confused with a knee injury known as patello-femoral pain syndrome, where the site of the pain is located in the kneecap or front of the knee. However, ITBFS is recognisable as having the pain located on the side of the knee and can be identified by bending the knee at a 45-degree angle. The two conditions seem similar but can be differentiated by the location of the pain.

Mobility on stairs

Anyone suffering with iliotibial band friction syndrome will experience a sharp pain and a sore knee when going up or down stairs or when they get up out of an armchair or a car.

Prevention of ITBFS

To prevent iliotibial band friction syndrome, athletes should do warm-up exercises with preventative stretching, and runners should ensure that they are running on a level surface or alternating sides of the road every other day. A holistic and balanced approach to training enables the athlete to rest and recover sufficiently.

Exercises to help strengthen the muscles of the knees

A physiotherapist will help to address the issues of ITBS by giving the athlete a few exercises to build up strength in the muscles on either side of the knee and to help with hip rotator and flexion. Leg squats are particularly good for building up the supporting muscles, but be careful to ensure that the pelvic alignment is balanced. Watching your progress in front of a mirror is a good idea.

Treating the pain

Conservative treatment of the pain will include resting from activity, perhaps modifying any sports equipment used, massage and physiotherapy, strengthening exercises and taking a course of non-steroidal anti-inflammatory drugs.

When doing an IT band syndrome stretch, the idea is to loosen and lengthen the bundles of muscle fibre in the mid-to-upper thigh by pressing them out with the base of the hand or by using a specialised foam roller supplied by your physiotherapist. Don't be too concerned if, when stretching, the pulling sensation does not occur where the site of the pain is: the IT band is a long fibrous structure.

Changing your exercise regime might help in order to engage a different set of muscles: you can cross-train, swim or do water aerobics, gentle cycling and rowing. Side stretches might also help, as will the application of ice-packs or heat-packs and an infrared lamp. Avoid stair-climbing if possible.

First Line of Defence for Iliotibial Band Friction Syndrome If your sore knee doesn’t resolve itself after a few weeks, it is best to get professional help. X-rays and scans might be necessary to detect deeper causes of any problem, and a cortisone injection could be given to break up scar tissue and help speed up healing. Be aware, however, that cortisone carries certain risks, as it can weaken ligaments and tendons.

If you notice ITB pain in your knee, make sure you stop and rest immediately. Reduce the amount of time you are involved in the activity that causes the repetitive rubbing of the tendon against the lateral epicondyle bone.

The last resort - surgery

If, despite rest and relaxation, stretching and strengthening exercises and anti-inflammatory medication, the sore knee problem persists, surgery might be the only remaining option. Surgery is only really recommended as a last resort and is best limited to highly motivated athletes or sports professionals who want to resume their sport or activity.

Arthroscopic surgery

Arthroscopy is a minimally invasive surgical technique used in the treatment of IT band syndrome and related sports injuries. It involves inserting a tiny fibre-optic camera attached to a thin cord into an incision near the joint in order to investigate ligaments, tendons, cartilage and soft tissue. Small instruments can then be used to repair broken cartilage or damaged tissue. Knee braces can be used to support the healing of the injured part.

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