Iliotibial Band Syndrome

Understanding Iliotibial Band Syndrome?

The iliotibial band (IT Band) is a strip of tough, dense connective tissue on the outside of the thigh, running all the way from the hip to the knee.  The iliotibial band plays an important role in stabilizing the knee and transferring force between the hip, knee, and lower leg.  Under normal circumstances, the iliotibial band will gently slide over the lateral femoral condyle (the end of the thigh bone that makes up the knee) as the knee flexes and extends.  However, if the iliotibial band becomes tight it will rub too hard over the knee.  If not addressed this will damage the iliotibial band, creating pain on the outside of the knee.

Signs and Symptoms of Iliotibial Band Syndrome?

  • Pain on the outside of the knee
  • Pain can initially be dull or achy, but often becomes sharp and more severe in later stages
  • Pain is often worse with running or walking
  • The outside of the knee is often tender to touch
  • In the early stages, pain symptoms usually improve with warm-up or exercise
  • In later stages, pain may worsen and be present during activity.

What Causes Iliotibial Band Syndrome?

Iliotibial band syndrome is an example of a repetitive strain injury.  Unlike a traumatic injury which is caused abruptly following a trauma or accident, repetitive strain injuries (referred to as an RSI for short) are associated with very small amounts of tissue stress and damage that accumulates slowly over time and cause pain.

Here’s how this works….

As the iliotibial band and surrounding muscles are stressed and over-used it can lead to small scale damage.  This damage is referred to as ‘micro-trauma. Although only small this damage still needs to be repaired.  The body does this by forming new tissue in and around the injured tissue, in this case, in and around the iliotibial band. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.  For an analogy, think of a big rubber band with a pinprick in it.  This little pin-prick does not affect the rubber band much, but we still want to repair it so we put a little dab of glue over the area.

If the overload at the iliotibial band continues (this is almost always associated with problems at the hip or foot, which will be discussed below) there will be ongoing micro-trauma and subsequent repair of this micro-trauma. Overtime, this scar tissue will build up and will start to interfere with the normal strength and flexibility of the ilitibial band and surrounding muscles.  Going back to our analogy, think of this as more and more pinpricks in that rubber band, followed by a big build-up of glue around the area.  This will, in turn, make the rubber band tighter and less elastic.  In the case of the iliotibial band, it is also common for these adhesions to glue the IT band to the underlying quadriceps muscle.  When this happens the iliotibial band and quadriceps cannot move and slide over one another,  creating even more friction and irritation at the lateral hip, thigh, and especially the knee.  At this point, pain and tightness at the knee and surrounding area will start to become noticeable.

Why the hip and foot are important with knee pain

It is important to realize that virtually every RSI involving the knee – including iliotibial band syndrome – is related to a problem at the hip, pelvis, and/or foot.  If these key joints are not working properly it will create excessive stress and overload at the knee. This will often be seen as a misalignment of the knee during activities such as walking, running, climbing stairs, or with exercises at the gym.  (“Do you want to know if your knee pain is linked to a problem at your hip or foot – try a squat test, 1 leg squat test, or lunge test).  This altered alignment will increase the demand on the muscles of the leg as they must work harder to move and protect the knee, and try to pull the knee back into the proper alignment.  Based on our experience in treating knee pain, hip and/or foot problems actually occur in about 90% of non-traumatic knee problems.  If these issues are not addressed the knee pain will not fully resolve, and will likely come back in the future.

Treatment – Resolving Iliotibial Band Syndrome

The proper treatment of iliotibial band syndrome must not only address pain and tissue damage at the iliotibial band and knee itself, but MUST correct any biomechanical problems at the foot and/or hip and pelvis.

For treatment to be effective we have found that there are certain steps that must be followed, and these steps must be performed in the right order if we are to expect the right results.  Here is our approach when treating iliotibial band syndrome in our clinic….

Step 1 – Resolve scar tissue adhesions and facilitate healing

Perhaps the most critical step is to treat the scar tissue adhesions.  These adhesions are a sign that the muscles are not healthy, and unhealthy tissue will not respond well to traditional stretches and exercises – think of trying to stretch out that rubber band caked with glue. Resolving scar tissue adhesions is a critical step in resolving knee pain, including iliotibial band syndrome, but it is often a missed or underappreciated step as many practitioners do not have the clinical skills to address this problem.

Scar tissue adhesions do not resolve with stretching or traditional massage or soft tissue methods, but instead must be treated with advanced soft tissue techniques.  One of the most effective methods is to use a technique known as Active Release Techniques (ART). For those who are unfamiliar with this treatment method, ART is a new and highly successful hands-on treatment method that was specifically designed to identify and address scar tissue adhesions that are interfering with the normal movement of the body.

During an ART treatment, the practitioner will first shorten the muscle, tendon, ligament, or joint capsule and then apply a very specific tension with their hands as they stretch and lengthen the tissues.  As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment.  When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.

Step 2 – Correct strength and flexibility

Simply treating the scar tissue adhesions will make the damaged tissue healthier, and will often result in a significant reduction in pain.  In fact, it is not uncommon to see a significant improvement in just a few visits.  However, although addressing the scar tissue makes the iliotibial band and surrounding muscles healthier, they may still be somewhat tight or weak.  When this is the case-specific stretches or exercises can be incorporated into a home exercise/rehabilitation routine to help support in-office care. Initially, the focus is on correcting local muscle deficiencies (i.e., at the knee, hip, or foot).

Step 3 – Re-Train Functional Movement Patterns

The final stage with treatment is to ensure proper alignment and movement coordination of the foot, knee, hip, and trunk with functional movement patterns.  This ensures movement of the hip, knee, and foot are coordinated and working together as a unit.  This is what is required during real-life activities such as running, walking, cycling, and climbing stairs (the key functional movement patterns with respect to patellofemoral pain syndrome include the squat, 1 leg squat, and lunge).