Runner's knee - The Iliotibial Band and Its Syndrome

The Iliotibial band is thick tendon with the tensor fascia latae and gluteals attaching. This band passes down the outside of the thigh and inserts just below the knee. Its role is to stabilise the knee, hip and pelvis.

Iliotibial Band Syndrome

This is the result of the band becoming tight, pulling the knee out of alignment and causing rubbing on the outside of the knee joint. Even though the band stretches from the pelvis to the knee, pain is normally experienced on the outside of the knee as indicated in the picture. Other symptoms can be discomfort on the outside of the leg around the bony prominence of the hip.

Pain will normally occur at the same time in an activity, and stop when walking. If left untreated inflammation will worsen, with pain starting earlier into the activity and becoming more intense. This can develop into near continuous pain.

What Causes Iliotibial Band Syndrome?

There are two main causes of iliotibial band syndrome, overload and biomechanical.

Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner's injury. When the tensor fasciae latae muscle and iliotibial band become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in-turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.

There are a number of causes of overloading, including:

• Exercising on hard surfaces,
• Exercising on uneven/slippery ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise too quickly;
• Exercising in worn out or ill fitting shoes;
• Excessive uphill or downhill running.

Biomechanical causes include:

• Leg length differences;
• Tight, stiff muscles in the leg;
• Muscle imbalances;
• Foot structure problems
• Gait, or running style problems.

Immediate Treatment for Knee Pain

The basic treatment for knee pain resulting from ITB Syndrome is no different to most other soft tissue injuries. The R.I.C.E.R. regime should be applied. Rest, Ice, Compression, Elevation, and Referral to an appropriate professional. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

As with any injury it is important to identify the cause and remove it.

Ongoing Treatment and Prevention
The cause is from the muscles supporting the leg, ie the gluteus maximus and tensor fasciae latae. Other muscles supporting the back, and the leg may also be involved, including the piriformis.

Massage, stretching and strengthening are all important techniques to be employed to stabilise the leg and reduce the loading on the ITB. It is also important to refrain from any exercise that exacerbates the pain until it is improving. This may mean that you can continue to run, but stopping before the pain starts. Water based exercises are a good way to maintain cardiovascular fitness and keep the load of the ITB.

Some Good Stretches:

Keep yourself square and lean away from the wall
Place a foam roller underneath the bottom leg and roll.
Initially, with a tight ITB this will be painful.
As the band loosens, it will become much more comfortable.

A Gluteal conditioning exercise:

This exercise is repeated in three positions. Holding for 10secs and repeated 10 times

1)      foot turned towards the floor

2)      foot level with the floor

3)      foot turned towards the ceiling.

To make sure that the gluts are working and not the quadriceps, position the top leg further back than the bottom leg, making sure that your lower back is not arched.