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An introduction to the ITB and ITB Syndrome

 Iliotibial Band Syndrome

Iliotibial Band Syndrome is one of the most common causes of ‘Runners Knee’ accounting for up to 22% of overuse injuries in runners. Recover Sports Medicine will be looking at Iliotibial Band Sydrome or ITBS, thanks to one of our Senior Physiotherapists Scott Hancock.

Scott will explain what the Iliotibial Band is, its function in the body, what ITBS is and the causes of this syndrome, and finally how to treat ITBS including the state of the art technology we use here at RSM.

  

What is the ITB and what is its function?

 The ITB is a thick fibrous structure or band of fascia which originates from the Tensor Fascia Lata and Gluteus Maximus muscles on the outside of the pelvis, travels over the hip and knee and inserts just below the knee on the lateral condyle of the Tibia, known as ‘Gerdy’s Tubercle’.

 The ITB and its associated muscles assist the stability of the leg during the stance phase of walking and running, which is the time from initial foot contact to propulsion. It also works with the hip muscles in abduction (outward movement) of the thigh, and helps to resist torsional movements around the knee joint.


What is ITBS and what are its causes?

 The longstanding theory is that the IT band moves backward over the femoral condyle as the knee bends and forward as the knee extends creating friction, inflammation and pain. However recent literature has challenged this view highlighting that there is a highly innervated layer of fat between the femoral condyle and the ITB and it is this that becomes inflamed and painful.

 Irrespective of the underlying pathophysiology the result is pain in the lateral (outside) portion of the knee, above where the ITB crosses the joint.The pain usually occurs just after initial contact of the foot with the ground and gets progressively worse as a run or walk goes on and particularly with downhill and long, slow running.

With respect to ITBS it is imperative to determine the specific cause of your symptoms with one of our Physiotherapists at Recover Sports Medicine.

It isn’t just tightness of the ITB that’s an issue, it’s also the load and stress on the ITB and the frequency at which it finds itself under load.

 

The common causes of ITBS are as follows:

  1. Weakness of the Hip Abductor muscles (mainly the Gluteus Medius and Minimus). The Glut Medius and Minimus muscles abduct the hip, taking the leg away from the body. If the Glut Medius or Minimus muscles are weak and not engaging well, then another muscle, Tensor Fascia Latae (TFL) often becomes more active to compensate. As the TFL attaches to the ITB this can place greater tension on the ITB and contribute to the problem.
  2. An increase in volume and type of training, i.e a dramatic increase in the kilometres you are     running each week, or the inclusion of hill running or speed intervals without the appropriate underlying strength and movement control.
  3. Tissue Flexibility: Restriction or a lack of flexibility of the Hip Flexors, Quadriceps and TFL muscles.
  4. Poor movement control, biomechanics and running technique.
  5. Other causes may include over pronation and poor pronation control, pelvic imbalances or a leg length discrepancy.


How do I treat and resolve my ITBS?

Identifying and addressing the causes of ITBS, with your Physiotherapist at Recover Sports Medicine, is a vital piece of the puzzle, if you just focus on settling the symptoms it will likely return when you start to run. Having said that, settling the symptoms is essential if you want to rehabilitate and return to running.

 

The initial phase of your rehabilitation is aimed at reducing your pain and any inflammation.

Upon review with your Physiotherapist this initial phase may involve:

  • Rest and a reduction in running volume.
  • Ice
  • Anti-Inflammatories (Discussed with your GP)
  • Massage, Foam Rolling and Trigger Point releases to address TFL, Hip Flexor and Quadriceps tightness.
  • Stretching to address the above mentioned restrictions
  • Patello-Femoral taping and Patella Mobilisations.
  • Strengthening exercises to start to address any Gluteal, Quadriceps or Hamstring weakness.

 

As you progress through this initial phase and your symptoms start to settle it is important that your biomechanics, movement control and running technique are addressed and that your strength program is gradually progressed.

The team at Recover Sports Medicine utilise the state of the art Bio Motion Laboratory to accurately assess a number of key functional movements, dynamic tasks and your running technique. The Bio-Motion Lab is the most advance marker less motion capture system used in Australia and utilises its 14 high speed cameras to qualitatively and quantitatively assess your movement patterns. From this assessment an appropriate treatment and return to running plan is determined which may incorporate Clinical Pilates, Running Technique Drills and Alter Gravity Treadmill Training.

 

Clinical Pilates at Recover Sports Medicine is instructed by Pilates trained Physiotherapists in a one on one or group setting and is prescribed to address specific weakness, muscular tightness, joint stiffness and to address altered mechanics related to your running.
 
Don’t hesitate to give the team at Recover Sports Medicine a call on 1300 858 774 to address your ITBS, for a Running Assessment or regarding your running related injuries.

 

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