Iliotibial band friction syndrome (ITBFS)
The iliotibial band (ITB) is a thick band of connective tissue that stretches from the outside of the pelvis down past the knee joint to the lateral tibial condyle (lower leg bone). There are two muscles which insert into the iliotibial band, the Gluteus Maximus and Tensor Fascia Late. The iliotibial band is important in providing lateral stability to the knee.
What is iliotibial band ITBFS?
- Iliotibial band friction syndrome (ITBFS) is a classified as an overuse injury and is a common in distance runners.
- During the running gait as the knee repetitively extends (straightens) and flexes (bends) the iliotibial band can rub on the outside to the femur (thigh bone), this may cause repeated friction, thus causing inflammation of the band or underlying tissue.
- The width of the Iliotibial band varies considerably from individual and this may predispose some people to developing iliotibial band friction syndrome – ITBFS.
What type of pain is it?
The symptoms of Iliotibial band friction syndrome may be described as a stinging or aching on the outside of the knee.
What causes ITBFS?
- There are many contributing factors which all subject the Iliotibial band to extra load and to developing ITBFS, the most common are;
- Training errors such as a sharp increase in training or training volume, insufficient recovery
- Abnormal biomechanics of the lower limb (hip, knee and foot)
What aggravates the pain?
- The pain will get worse as a run progresses and can persist sometime after completion of the run.
- Longer runs or those on uneven surfaces
- Down hill runs because the knee flexion angle in foot stance is reduced
- Faster runs tend to be better tolerated because at foot strike the knee is flexed beyond the angle where friction normally occurs.
How is ITBFS Diagnosed?
- A history indicating classic symptoms and a clinical examination provide the information to give a diagnosis. Imaging is rarely necessary.
- The clinical examination will include a lower limb biomechanical assessment to identify any risk factors which may have lead to the injury. This will include an examination of the pelvis, hip, knee and ankle and specifically how they function together in running and walking.
- There is a point of tenderness which may not be apparent in a resting position but when the Iliotibial band is put on stretch this will be painful.
- Muscle imbalance particularly weak gluteal and quadriceps muscles
- Tight calves or hamstring muscles
- Poor functional core stability
ITFBS is not an easy condition to treat even if you have the best advice, so if you do think you may be suffering then it is best to seek expert advice straight away.
How is ITBFS managed?
- It is essential to have an assessment by a sports therapist to ensure that management is tailored to your individual needs
- Activity modification – avoid all pain-provoking activities and address any training errors
- Local treatment – dry needling, ice, anti-inflammatory gel
- Injection therapy – corticosteroid injection into the bursa between the Iliotibial band tendon and the underlying femoral condyle.
- Manual therapy – soft tissue release to Iliotibial band and associated muscles around the hip and knee
- Therapeutic exercise to address any muscle imbalance.
- Slow progression back to sport due to the overuse nature of this injury