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Iliotibial Band Syndrome

The true story behind this stubborn knee pain.

Iliotibial band syndrome (ITBS) is a common knee injury often found in those who participate in activities that involve repetitive flexion (knee bends) and extension (knee straightens out) Running, cycling, and hiking are examples of these offending activities.

What is the ITB?

The ITB travels from the outside of the hip, thigh, and knee, and inserts below the knee on a bump on the lower leg bone. The gluteus maximus (buttocks muscle) and tensor fascia lata (TFL) (outside of the pelvis muscle) attach to the back and front of the ITB respectively. When all is working properly, the gluteus maximus and TFL contract and increase tension on the ITB, aiding in stabilization of the hip and knee joint.

What hurts when the ITB is a problem?

The first symptom of ITBS can feel like a mild ache on the outside of the knee. The ache initially may not hinder training, and the discomfort may even disappear before the next training session. If training continues without proper treatment, the mild ache on the outside of the knee could progress to a burning or stabbing sensation, which can then radiate to the outside of the thigh and even to the calf.

What causes the ITB to be a problem?

This is an important distinction to make. The ITB may cause the PAIN, but it rarely is the PROBLEM. Something else in the body isn’t working properly and as a result the ITB tightens and becomes an issue. Here are some examples of common dysfunctions leading to ITBS.

1. ITBS can be a result of impaired function (weakness or inhibition) of the hip muscles. When these muscles do not function properly throughout the running cycle, there is a decreased ability to stabilize the pelvis and control femoral abduction (lateral motion of leg). The TFL must contract harder and for a longer period of time, thereby stressing the ITB. As a result, the ITB is overworked and becomes irritated.

2. Another area to assess in regard to ITB problem is hamstring function. The hamstring (big muscle on the back of the leg) is another knee stabilizer. A weak hamstring leads to an on overworked ITB. Many factors lead to hamstring weakness. One of the most common reasons is tension on the sciatic nerve (big nerve with branches coursing from the low back, through the buttocks, down the back of the legs to the toes). When the sciatic nerve is trapped, the hamstrings will not function optimally.

3. Other biomechanical abnormalities that may lead to ITB problems include excessive pronation (rolling in) of the foot, muscle tightness, or fascial adhesion.

4. Various training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage, and downhill running.

Recovery depends on the underlying cause of the injury and whether the athlete is compliant with the treatment. With proper assessment and treatment, ITBS does not mean an end to one’s running career.

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