ITB, ITBS, ITBFS, Runner’s Knee

Call it what you want, but issues with the Iliotibial Band can be hard to treat!
 
What is ITBS?
The ITB is a thick fibrous band that runs from the iliac crest and tensor fascia latae (TFL) muscle down the outside of the leg and across the knee joint, connecting to the outside of the patella on its route. It crosses both the hip and the knee joint and has a role in stabilising both.
The terms Iliotibial Band Syndrome and Iliotibial Band Friction Syndrome mean the same thing but there has been some debate about whether this condition involves "friction". The longstanding theory is that the IT band runs over the femoral condyle as the knee bends creating friction, inflammation and pain. Recent literature has challenged this view saying there is a highly innervated layer of fat between the femoral condyle and the ITB and it is this that becomes inflamed and painful. Either way the result is pain, usually felt on the outside of the knee and around the IT Band.
 
What causes ITBS?
So many treatments aim at symptom relief for the ITB but to get rid of an ITB issue long term you need to examine the cause and deal with that. It isn’t just tightness of the ITB that’s an issue; it’s also the load and stress on the ITB and the frequency at which it finds itself under load. For example a sprinter may have a really tight ITB, but only runs for 10-20 seconds in a race exposing the ITB to high loads but only briefly. A marathon runner with a slightly tight ITB will be running for upwards of 3 hours (obviously depending on level) so while the load might be lower on the ITB it is exposed to it for far longer.
 
Common Causes

Call it what you want, but issues with the Iliotibial Band can be hard to treat!

What is ITBS?

The ITB is a thick fibrous band that runs from the iliac crest and tensor fascia latae (TFL) muscle down the outside of the leg and across the knee joint, connecting to the outside of the patella on its route. It crosses both the hip and the knee joint and has a role in stabilising both.

The terms Iliotibial Band Syndrome and Iliotibial Band Friction Syndrome mean the same thing but there has been some debate about whether this condition involves "friction". The longstanding theory is that the IT band runs over the femoral condyle as the knee bends creating friction, inflammation and pain. Recent literature has challenged this view saying there is a highly innervated layer of fat between the femoral condyle and the ITB and it is this that becomes inflamed and painful. Either way the result is pain, usually felt on the outside of the knee and around the IT Band.

What causes ITBS?

So many treatments aim at symptom relief for the ITB but to get rid of an ITB issue long term you need to examine the cause and deal with that. It isn’t just tightness of the ITB that’s an issue; it’s also the load and stress on the ITB and the frequency at which it finds itself under load. For example a sprinter may have a really tight ITB, but only runs for 10-20 seconds in a race exposing the ITB to high loads but only briefly. A marathon runner with a slightly tight ITB will be running for upwards of 3 hours (obviously depending on level) so while the load might be lower on the ITB it is exposed to it for far longer.

Common Causes 

1. Increase in mileage/changes in training

If you can’t find a way to run pain free then you are going to need some proactive rest.

Rest. The R-Word. Why is it sometimes harder to rest than train!?

Rest will help the inflammation around the ITB to settle. Ice and anti-inflammatories are also highly advisable to help settle the inflammation too. 

There is an issue though with rest, when you run again the issue often comes straight back. This is part of the reason why people don’t want to rest. So Proactive Rest is the plan. Rest to let the inflammation settle, self treat to reduce the symptoms and deal with the underlying cause. 

How long should you rest your ITB? Tricky question, mild inflammation may settle in 2-3 days, more severe inflammation may require weeks. Be guided by your symptoms and most importantly of all have a graded return to running. Don’t go straight back to your previous level. Start with a slow, gentle jog and gradually build up with rest days between each run.

2. Muscle weakness – mainly Gluteus Medius, Gluteus Maximus and Medial Quads.

3. Tissue Flexibility

With ITBS the key areas are hip flexors and quads, TFL and the ITB itself. In addition anything that affects movement of the knee can have an effect e.g calf and hamstring tightness.

4. Movement Control

Strength is of little use without control

5. Biomechanics

These areas, although presented separately are all inter-linked i.e. foot position, leg length

 

Symptom Treatment

Identifying the cause of ITBS is an important piece of the puzzle, if you just focus on settling the symptoms it may well come back when you start to run. That said, settling the symptoms is essential if you want to rehab and return to running.

* Massage/foam roller – Start by massaging the non-painful areas of the ITB, including the TFL at the top. You can progress on to the more tender areas when tolerable. It should feel better after. If you are massaging an inflamed tender area and it’s just getting worse stick to the other areas of the ITB until it settles.

*Stretches – Surrounding muscles need stretching such as TFL, gluts, hip flexors, quads and lateral hamstrings.

*Taping to offload the ITB.

 

Closing thoughts…..

ITBS can be a complex and painful condition. Key strategies to manage are to find the cause, settle the symptoms, rehab what needs fixing then plan a gradual return to your normal running.