Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting (especially squats).

IBS is one of the leading causes of lateral knee pain in runners. The iliotibial tract is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

IBS symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.

ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight — each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known.

Sports activities to avoid while symptomatic

• Running
• Stair climbing
• Deadlifts or squats
• Court sports, such as tennis, basketball, or similar
• Martial arts, such as karate (especially where being bare foot emphasizes any symptoms being caused by leg/foot abnormalities)
• Cycling
• Bowling

IBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:

Training habits:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet “toed-in” to an excessive angle
• Running up and down stairs
• Hiking long distances

Abnormalities in leg/feet anatomy:

• High or low arches
• Over pronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
• Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bow leggedness for runners.

Muscle imbalance:

• Weak hip abductor muscles
• Weak/non-firing multifidi muscles

While pain is acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Massage therapy may also be beneficial. Using a foam roller to loosen the iliotibial band can help prevent and treat pain although the treatment itself can be very painful to some.