Iliotibial band friction syndrome in runners:
Iliotibial band friction syndrome (ITBFS) is also known as ITB syndrome and more commonly referred to as “runner’s knee.” This overuse injury is common in runners and in fact, accounts for up to 22 percent of all overuse injuries in runners.
The iliotibial band attaches to a bony protuberance (femoral condyle) on the outside of the knee and slides forwards and backwards across this bony point with movement. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which usually happens just as your foot strikes the ground in running. At this 30 degree knee bend angle, the structures on the outside of the knee can get irritated by the IT band, thereby creating the pain associated with ITBFS.
ITBFS sufferers will feel a sharp pain on the outside of the knee, just above the joint line, which is caused by friction of the iliotibial band on the side of the knee. There may also be associated local swelling and the pain usually develops at about the same distance/time during a run. Longer training sessions and downhill running are often aggravating factors for the pain.
What causes ITBFS?
The syndrome is commonly caused by poor running biomechanics due to underlying muscular imbalances, such as weakness or tightness of specific muscle groups with or without poor foot biomechanics.
A thorough assessment by an experienced physio will diagnose ITBFS, without the need for scans. Care must be taken by the physio to differentiate between ITBFS and two other common causes of pain at the outside of the knee in runners, in the area of the IT band- altered neurodynamics (poor movement of the nerve at the side of the knee) and referred pain from the lower back. These two causes of pain at the outside of the knee will not respond to the treatment for ITBFS and an alternative physiotherapy treatment approach is required to clear them. Consequently, a correct diagnosis is essential from the onset.
Physiotherapy treatment for ITBFS:
The physiotherapy treatment plan addresses the specific underlying causes of the ITBFS which willl have been identified on the initial assessment. Although the pain is felt at the IT band at the side of the knee, it is not the IT band’s fault! It is weakness or tightness of the muscles which have an effect on the IT band.
Apex Clinic recommends the following physiotherapy treatment plan to clear your pain:
1) Reduce/modify your running distance and ice the local area in the early stages.
2) The physiotherapist should perform soft tissue massage to the muscles at the top of the IT band, namely the glutes (bum muscles) and tensor fascia latae. We do not recommend use of a foam roller as it doesn’t address the underlying issues or appear to give any long lasting results.
3) Stretching exercises of the gluteus maximus muscle and of the tensor fascia latae muscle (which can easily be assessed online). Perform these stretches twice daily, five times for each muscle, holding each stretch for 20 seconds. The IT band itself can’t be stretched as it is attached into the entire length of the thigh bone, whereas the glutes and tensor fascia latae can be stretched.
4) Strengthening of the hip muscles (hip abductors and hip external rotators) is vital. Three exercises which strengthen these muscles are:
a) Lying on your side with sore side upwards and both knees straight. Raise the upper leg slowly upwards by 30 degrees and down again. Repeat three x 20 reps, twice daily.
b) Single leg squats, standing on the sore leg, in front of a mirror. The emphasis is on keeping your hips level and on moving your knee slowly over your toes of the foot you are standing on. Repeat three x 20 reps, twice daily.
c) Clamshell exercise. Lying on your side, sore side up, with your knees bent to 90 degrees. Lift your top knee away from your bottom knee slowly. Repeat three x 20 reps, twice daily.
5) Over the counter or custom made insoles (orthoses) may or may not be needed to improve foot biomechanics.
Surgery for ITBFS:
This is a last resort as most cases clear completely with the correct physiotherapy treatment. With the correct diagnosis and physiotherapy treatment, ITBFS in runners can be cleared, leaving you to enjoy pain free running.