Iliotibial band syndrome (ITBS or IT band syndrome)

Iliotibial band (IT band) syndrome is a common injury that causes pain on the outside of the knee. The IT band itself is a thick strip of fibers that runs from the outside of the hip to the outside of the thigh and knee down to the top of the shinbone. IT band syndrome arises due to friction at the point where the IT band crosses over the knee joint. This friction leads to inflammation, which in turn causes a painful tightening of the band. IT band syndrome is usually caused by physical activities that require repetitive bending of the knee, such as running, hiking, or cycling. It can also be triggered by improper training techniques or certain pre-existing physical conditions. Treatment for IT band syndrome usually involves little more than rest, over-the-counter pain medication, and simple alterations to physical activities. Surgical intervention is required only in particularly severe cases.

Background

The iliotibial band is a thick strip of tissue that connects several muscles in the lateral thigh. In other words, it runs along the outside of the thigh from just above the hip to just below the knee, connecting the hip muscles to the tibia in the lower leg. At its far end, the IT band connects to the lateral epicondyle of the tibia, a bony protrusion at the knee. The band itself is considered to be a deep fascia of the body. Deep fascia is made of dense regular connective tissue, which is a type of fibrous connective tissue that is extremely strong and tough. It is also avascular, which means that it does not contain blood vessels. This type of tissue is composed of collagen fibers and fibroblast cells. Fibroblast cells produce collagen, a natural protein that is one of the strongest structures in the human body. The collagen fibers in the IT band are arranged in a regular pattern of straight lines. This arrangement affords the IT band remarkable strength in the direction in which muscle force is applied and less so in other directions. Elastin protein fibers intermingled with collagen fibers within the IT band provide it with a certain degree of elasticity.

The IT band functions as an abductor, medial rotator, and flexor of the thigh. It also helps support the extension of the knee while a person is standing, walking, running, or biking. The IT band is critical to all forward, backward, and lateral running motions. Its most important function in such instances is preventing abduction, or inward movement, of the upper leg while the body is in motion. By protecting the large thigh muscle and acting as a barrier on the outer aspect of the thigh, the IT band also contributes to the stability of the quadriceps.

The natural motion involved in running and walking places considerable strain on the IT band. This inherent strain is increased by additional stresses place on the band by anatomic irregularities like uneven leg length that impact how the legs move during the running motion. Other factors, such as the direction or the angle in which a person is running, may also place additional stress on the IT band. Such stress can ultimately lead to IT band syndrome or other IT band problems.

Overview

IT band syndrome is a common overuse injury that occurs when the IT band becomes unusually taut or inflamed. This causes the band to experience increased friction where it crosses over the knee. Under normal circumstances, a fluid-filled sac known as a bursa allows the IT band to glide smoothly over the knee as the leg is bent and straightened. However, if the IT band is too tight, it increases friction during the bending motion. This friction can cause the IT band and the bursa to swell, which ultimately results in the pain associated with IT band syndrome.

The primary symptom of ITBS is pain on the outer side of the knee above the joint. This pain may subside after some warming up, but it can also escalate with continued exercise. IT band syndrome may also cause burning, aching, tenderness, warmth, or redness on the outside of the knee. It may also be accompanied by pain that shoots up or down the leg or a clicking, popping, or snapping sensation.

While ITBS can affect anyone, there are risk factors that may make some individuals more susceptible. Some of these factors include having pre-existing IT band tightness or injuries; having weak hip, gluteal, or abdominal muscles; walking or running on a track or uphill; sitting for extending periods; performing repetitive activities like running or cycling; or having issues like knee arthritis, unbalanced leg lengths, bowlegs, or flat feet. In addition to runners, hikers, and cyclists, IT band syndrome may also be more likely to affect athletes such as basketball and soccer players who make extensive use of their knees. Poor training techniques, including failure to properly warm up, cool down, or not resting between workouts, can increase the likelihood of experiencing ITBS.

Diagnosing IT band syndrome is a relatively straightforward task. In most cases, the condition can be diagnosed with a simple physical examination that includes tests of range of motion and strength. Additional imaging tests like X-rays or MRIs may also be necessary to rule out other possible issues.

The most important part of treating IT band syndrome is following the RICE protocol. Rice stands for Rest, Ice, Compression, and Elevation. Resting the affected knee, or at least cutting back on physical activity, is the first step in treating ITBS. Icing the outside of the knee for fifteen-minute sessions every two hours may also help reduce inflammation and soothe pain. In addition, it may be advisable to wrap an Ace bandage or an IT band compression pad just above the knee joint so as to stabilize the knee and reduce friction. Keeping the affected knee elevated during icing period may also bring some relief. Beyond the RICE protocol, healthcare providers may recommend taking over-the-counter nonsteroidal anti-inflammatory (NSAID) pain medication or getting a cortisone injection. In particularly severe or chronic cases of IT band syndrome, surgical intervention may be required. The most common surgical option for treating ITBS involves removal of the part of the IT band that glides over the femur.

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