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Iliotibial Band Syndrome? A Pain in the Runner's Knee!

If you have just started running, you probably have no idea what an iliotibial band is, let alone where it is in your body. If you have been running for years, you fondly refer to it as your "IT band". This is a very commonly irritated area in a distance runner's body. Definitely a top ten injury contender!

So what and where is your IT band? It is a fibrous band that runs on the outside of your thigh and attached to the hip at the top and to the outside of just below your knee at the bottom. The central feature of this band is a very important muscle, the tenor fascia lata. Most anatomy books describe the TFL as a hip abductor. Really, this is a key muscle that controls and decelerated the adduction of your leg in gait. A very important part of running unless you like your leg flapping around and like to run like a ballerina! This control equates to an eccentric load on this muscle and band at least 90 times a minute while running. Very tense and overworked area in a runner! No wonder it likes to complain from time to time!

What does ITB syndrome feel like? A big pain in the knee! But seriously, a pain that usually starts after an intense workout in the outside of your knee. It can radiate from your outer hip down towards your knee as well. The pain is usually pretty sharp and starts after a few miles into your run. This injury does not "warm up" like most tendon injuries. It gets worse when running downhill or on uneven surfaces. It usually will persist until you stop and walk. In the early stages, the pain goes away when you stop running. A mild amount of swelling on the outside and below your knee can occur. Some people will even have some tingling down the outside of their lower leg. If you continue running with this injury, it can get very debilitating to the point that the pain only goes away when walking with your knee locked in a stiff legged manner.

Why do runners get ITB syndrome? Too much, too soon, too fast syndrome is the easy answer; but this is not just an overuse injury. Many runners who run only short mileage can suffer ITB syndrome. This is usually due to a combination of weakness in the tensor fascia lata and other hip abductors, and lack of flexibility of the IT band. Couple this with a fondness for running on the same side of the road or around an oval track; bow legs, a leg length discrepancy and an excessively mobile flat foot or flexible high arched foot type and you have IT band syndrome!

How is ITB syndrome diagnosed? There is a specific test for ITB syndrome called the "Noble compression test". The test is performed by the physician placing their thumb over the lateral epicondyle of your upper leg and then you flex and extend your knee. If you tend to jump off the table when at about 30 degrees of knee flexion then you probably have ITB syndrome. Why? When your leg is straight, the ITB is in front of the epicondyle; in knee flexion, the ITB actually passes over the lateral epicondylar surface. If your ITB is inflamed, the friction caused by this motion is quite painful, especially when your doctor is compressing the ITB on the bone. An at home test that is similar is to stand with all your weight on your painful leg and flex the knee to about 30 degrees. If you have ITB syndrome, you will feel pain with compression to the outside of your knee.

What are the best treatments for ITB Syndrome? The first line treatments are relative rest (yes, that means slow down and stay off of hills and uneven surfaces), icing, anti-inflammatories and lots of stretching. But remember, it is a combination of weakness and lack of flexibility as well as instability; so stretching is almost never enough. Lots of people have ITB syndrome and just rest until is stops hurting, just to rear its ugly head when you start running again! You have to get to the root of the problem! Strengthening of gluteus medius, as well as the other hip abductors is an essential part of the rehabilitation of ITB syndrome. You also need to treat any excessive foot pronation, supination or leg length discrepancy. Custom orthotics are often needed for long distance runners.

Bottom line, ITB syndrome can be quite the persistent pain in a runner's knee. This pain often lingers for months and even years because of treating the symptoms and not the root of the problem! Stretching, strengthening and control of instability are key components to the successful rehabilitation of this common injury.