The Iliotibial band is a thick tendon that inserts on the outside of your knee. The function of the Iliotibial band is to help slow movement and torque at your knee during impact. Iliotibial band syndrome is a common cause of knee pain in runners.
The cause is repetitive trauma to the Iliotibial band insertion on the outside of the knee resulting in tendonitis and severe lateral knee pain while running. Eventually this condition will result in degeneration of the tendon and progress to a condition called tendinosis. This means there will be excessive tightness due to abnormal scar formation and may become a source of chronic knee pain for the runner.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose Iliotibial band syndrome – investigations such as an ultrasound or MRI may be used to assist with diagnosis.
Most cases of Iliotibial band syndrome settle well with appropriate physiotherapy. This requires careful assessment by the physiotherapist to determine which factors have contributed to the development of the condition, with subsequent correction of these factors.
The success rate of treatment is largely dictated by patient compliance.
The key components of treatment
The patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the ITB should be minimised, these include: running, squatting, jumping, and going up and down stairs.
Exercising into pain must also be avoided. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times.
The R.I.C.E regime is beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with rest).
The use of a compression bandage and keeping the leg elevated.
Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Exercises. Patients should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. One of the key components of rehabilitation is pain-free stretching of the ITB along with pain-free strengthening of the vastus medialis obliquus muscle (VMO). This is often in combination with core stability, pelvic and gluteal strengthening exercises to improve the control of the knee with weight-bearing activities.
Your Physiotherapist can advise which exercises are most appropriate and when they should be commenced.