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Iliotibial Band Syndrome

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  • Iliotibial band syndrome (or ITB syndrome or ITBS) is a common running related injury in which the iliotibial band (a band of tissue that runs along the outside of the thigh and stabilizes the knee) becomes inflamed due to friction, causing pain along the outside of the knee and the lower thigh.

    What causes Iliotibial Band Syndrome?

    Iliotibial band syndrome is typically an overuse injury.  The iliotibial band, which is a thick band of tissue that runs from the hip along the femur on the outer thigh, through the outside of the knee, and connects to the tibia (shin bone) below the knee, becomes inflamed due to repeated friction as the band rubs along the femoral condyle when flexing and extending the knee.  This condition is most often seen in runners or athletes that run a good deal during their sport.  ITBS can be caused by anything that causes an imbalance in biomechanics in the body, such as overpronation of the feet, differences in leg length, muscles tightness or weakness in the legs, pelvic tilt, bowleggedness, or running on a sloped or unbalanced surface or a circular track.  The condition can also be caused by increasing the duration or intensity of training too quickly, overtraining, inadequate warming up prior to activity, returning from another injury too soon, or improper footwear.

    What are the symptoms of Iliotibial Band Syndrome?

    The primary symptom of iliotibial band syndrome is pain that is felt along the outside of the knee joint, where the iliotibial band crosses from the femur to the tibia, stabilizing the knee.  Pain is most often felt towards the top of the knee joint, but can also be felt below the knee or along the entire iliotibial band up to the hip.  Initially pain may be felt towards the end of training, but eventually as the condition worsens it may be felt throughout all activity and even when at rest.

    How is Iliotibial Band Syndrome diagnosed?

    A medical professional will take a complete medical history and will perform a physical exam.  Questions will also be asked related to the type and severity of symptoms, when they began, and what makes them better or worse.  A medical exam will include feeling the area around the thigh and knee for tenderness and swelling and moving the knee in certain ways to determine when pain is felt.  X-rays, ultrasound or magnetic resonance imaging (MRI) may be used to see if there are other conditions or injuries causing pain, but are not necessary for diagnosing this condition.

    When should I seek care for Iliotibial Band Syndrome?

    If you experience pain, tenderness, or swelling in your knee that does not improve following a period of rest and avoidance of activities that cause pain you should seek medical advice.  If your symptoms are caused by a traumatic injury, such as a fall or hard blow, or pain is accompanied by immobility or redness, warmth, or fever you should seek immediate medical attention.

    What will the treatment for Iliotibial Band Syndrome consist of?

    Initial treatment of iliotibial band syndrome begins with rest, ice, compression and elevation of the affected leg.  Nonsteroidal anti-inflammatory medications can be taken for pain and to reduce inflammation.  Once the injury has had a brief time to heal, physical therapy is often recommended and may include strengthening, stretching and flexibility exercises, as well as ultrasound, massage therapy and myofascial release to help the tissues heal more quickly.  Once activity is resumed, it is important to begin slowly, increase training gradually and avoid overtraining.  Rest and recovery time between training is an important aspect of keeping the condition from returning.  Surgery is rarely performed to treat ITBS and is a last resort option only if all other treatment methods fail to bring relief from symptoms.

    Which muscle groups/joints are commonly affected by Iliotibial Band Syndrome?

    Iliotibial band syndrome causes pain primarily along the outside of the knee joint, but can cause symptoms anywhere along the length of the iliotibial band, which begins in the pelvis, running through the hip, along the outer thigh and outside of the knee, and connecting to the tibia (shin bone) below the knee joint.

    What type of results should I expect from the treatment of Iliotibial Band Syndrome?

    Most cases of iliotibial band syndrome respond to conservative treatments as long as the area is allowed sufficient rest from activity.  Physical therapy is often an important part of a successful recovery.  Since ITBS can become a chronic overuse injury, steps must be taken to avoid a recurrence of symptoms, including increasing duration and intensity of training gradually, avoiding overtraining, wearing proper footwear, performing stretching and strengthening exercises, and heeding any other advice provided by a medical professional or physical therapist for avoiding a recurrence of the injury.