It’s a complicated-sounding condition, but a surprisingly familiar foe for sporty people – especially runners. Iliotibial Band Syndrome – also known as IT Band Syndrome or ITB Syndrome – causes plenty of frustration when it strikes. So how does the problem come about, and what can you do about it?
Where is the iliotibial band?
It’s a thick, fibrous tendon that runs all the way down the outside of the leg, starting at the pelvis and ending in the outer side of the knee.
What does the IT band do?
It provides crucial stability to the hip and knee joints as they work together with nearby muscles like the gluteus maximus and tensor fasciae latae. It also helps to control posture, movement, and lifting of the leg.
What does IT band pain feel like?
Most people experience it as a sharp pain or ache on the outside of the knee (where the IT band inserts into the joint), which feels tender to the touch. Sometimes this is accompanied by swelling around the joint, and occasionally pain in the hip too.
When does it happen?
It’s brought on by exercise, particularly if you’ve recently returned to a regular activity or are upping your mileage: for instance, training for a marathon. Runners often find it strikes at the same distance each time and gets worse if they try to carry on.
What causes the pain?
ITBS is often described as a friction problem. As the band passes over the knee, it rubs against the lower, outer end of the thighbone. This irritates the iliotibial tissues and bursa, causing pain and inflammation. Any swelling will make the friction worse, which perpetuates the problem.
What causes the flare-up in the first place?
It can be difficult to say. One potential culprit is weakness in the hip muscle, or an overly tight IT band (or both). There may be other biomechanical issues at play too; for example, a muscular imbalance that affects the way your knee joint moves or that causes you to develop an uneven running style.
Does anything make it worse?
Trying to run through ITB pain doesn’t help; it usually increases the discomfort and inflammation. Other underlying factors people tend to overlook are footwear (using worn-out shoes that have lost support, for example) and surfaces – running on slippery inclines or uneven ground.
How would you know if you have IT band syndrome?
It’s important to get a proper diagnosis, partly to eliminate other outer-knee issues like a meniscus tear, arthritis or a posterolateral corner problem. We’re finding ultrasound scans can be particularly helpful for investigating ITBS. Because they produce a dynamic image of the knee, we can see what’s happening to the tendon as it moves, or if there’s inflammation where it inserts into the joint.
What can you do about IT band syndrome?
The first thing is to stop the activity that’s provoking the pain. Alternatively, if the discomfort is mild, you might look to reduce the intensity of the workouts or the distance you’re covering. Other self-treatments that GPs and consultants often recommend for ITBS include:
Rest – letting the inflammation subside naturally, to avoid the vicious cycle of friction and swelling
Ice – applying an ice pack to reduce the inflammation immediately after exercise
Activity modification – temporarily switching to lower-impact exercise, such as swimming
Running style – asking a sports therapist or specialist running shop to analyse your gait and posture
Footwear – looking into shoes that better support your feet, or help correct issues with your gait
Many patients find physiotherapy makes a big difference to IT band syndrome too. A physio can give you case-specific exercise plans that build strength in the supportive muscles around the IT band. This takes pressure off the knee and helps to avoid ‘overload’ of the joint. A common ITB exercise is a leg-stretch with an elasticated band around both ankles, gently moving the leg sideways to strengthen the pelvic muscles. As ever, though, it’s important to get a full diagnosis and tailored recommendations from an expert first. Iliotibial band syndrome can be highly frustrating but, with the right advice and treatment strategy, most keen runners find they’re able to conquer it and keep doing the thing they love.
For further reading…
IT band syndrome: patient information sheet from the BMJ
