Iliotibial Band Syndrome (ITBS)

Illiotibial band syndrome, or ITBS, is an overuse injury that affects the connective tissues located on the outer part of the thigh and knee. It is the most common cause of lateral (outer) knee pain in runners and bicyclists.

Knee Anatomy

The iliotibial band is a thick band of tissue that begins at the pelvis, runs down the outside of the thigh, and crosses the knee, where it attaches to the top part of the tibia or shinbone. This helps to stabilize the outer part of the knee. It also helps with knee flexion and extension.

When the knee is flexed, or bent, the IT band slides behind the femoral epicondyle, which is a bony point of the femur located at the knee. When the knee is extended, or held out straight, the IT band moves forward across the condyle. Should inflammation occur in this area, the friction from the repeated rubbing of the IT band across the condyle can cause pain and discomfort in the outer part of the knee joint.

Illiotibial Band Syndrome Causes

Illiotibial band syndrome is just another name for inflammation of the IT band, and it can be caused by multiple things. It is most common in runners or bicyclists. 

It is possible to be predisposed to developing ITBS if you have certain anatomical issues such as:

  • A leg-length discrepancy
  • An abnormal tilt to the pelvis 
  • Bowed legs 

These conditions can cause the IT band to tighten, leading to increased friction and irritation during the passage of the IT band across the femoral epicondyle. 

Training errors can also cause ITBS. Roads are naturally sloped from their edges, so that the middle of the road is higher up than either edge, for drainage purposes. If a runner only runs on one side of the road, this can have the same effect that leg-length differences have, because one leg will always be downhill compared to the other.

Bicyclists are also prone to develop IT band inflammation if they do not engage in proper posture on their bikes, such as if they turn their toe inward while they pedal. This causes the same effect as bowed legs, increasing the angle of the IT band as it crosses the knee.

Any sports activity that includes excessive squatting can also cause ITBS. 

Illiotibial Band Syndrome Symptoms

Common symptoms associated with ITBS include:

  • Pain on the outer side of the knee
  • A sensation of stinging or needle-like pricks, which will gradually progress to pain whenever the heel strikes the ground 
  • A snapping or popping sound at the knee
  • Swelling

Illiotibial Band Syndrome Diagnosis

Your doctor will likely be able to diagnose iliotibial band syndrome based on your symptoms. The sensation of pain on the outer side of the knee that worsens when the heel strikes the ground is relatively unique to iliotibial band syndrome. 

Your doctor will also likely conduct a physical examination; there will be tenderness centered over the bony point of the hip.

If the diagnosis is still unclear, an MRI can be used to to assess inflammation around the iliotibial band. An MRI can also exclude other sources of lateral knee pain, such as a meniscus tear or inflammation in the tendons. However, the majority of the time, imaging tests are not needed to diagnose this condition. 

Illiotibial Band Syndrome Treatment

There are myriad nonsurgical remedies that can reduce the pain and discomfort associated with iliotibial band syndrome. 

All treatments will likely begin with the RICE method: rest, ice, compression, and elevation. Utilizing this method will go a long way in reducing pain and swelling.

Anti-inflammatory medications like ibuprofen and naproxen can also be helpful if pain and swelling persists.

In conjunction with these treatments, your doctor may also prescribe physical therapy. Physical therapy treatments will generally focus on flexibility and stretching. The physical therapist will also look at the underlying cause of ITBS, and help you adapt your exercise technique to prevent future injury.

If your condition is severe enough, or if other treatments prove ineffective, therapeutic ultrasound techniques can also  be helpful in decreasing irritation surrounding the iliotibial band.

These techniques include:

  • Phonopheresis, in which ultrasound waves propel anti-inflammatory medications through the skin and into the inflamed tissue, and
  • Iontophoresis, where electricity rather than ultrasound waves are used to propel the anti-inflammatory medications.

There is also plenty of research indicating that the injection of corticosteroids are helpful in reducing inflamation and irritation.

Occasionally, nonsurgical treatments may fai, though this is very unusual. In these cases, orthopedic surgery is an option. A procedure can be performed to cut away the infected and inflamed part of the IT band. This can be done arthroscopically, and is minimally invasive. 

Illiotibial Band Syndrome Prevention

When it comes to ITBS, prevention can be relatively simple. Maintaining strength and flexibility in the lower back, hips, knees, and leg muscles can prevent inflammation and infection from occurring in the iliotibial band. Keeping your workout varied can also be an effective preventative measure.

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