What is Iliotibial Band syndrome?

Iliotibial band syndrome (ITBS) is a common issue seen in runners, or those who have recently taken up running.  But it’s not only seen in runners, it is generally present in those who perform repetitive knee bending and straightening (e.g. cycling, rowing).  ITBS is characterised by a burning or sharp pain around the outside of the knee just proximal to the joint.  It will usually start at a consistent time or point during your run or ride; (for example it may always start at the 3km point, or around the 30 minute mark) and symptoms will continue to get worse during the activity.  It could also be further aggravated by downhill running.

What Causes ITBS?

Although the name implicated the IT band as the source of symptoms, it is actually a highly innervated and vascularised (nerve supply & blood supply) fat pad that sits underneath the IT band that gets inflamed and irritated due to repetitive impact.  The fat pad sides just above the knee on the outside and is a ‘cushion’ that works to reduce irritation.  If the repetitive compression is above what the fat pad can tolerate the area can become painful and swollen.  The “impingement zone” is around 30 degrees of knee flexion, which is the approximate angle at which your foot strikes the ground in running, hence with high repetition there is the irritation of these structures.

ITBS primarily flares up due to a spike in training load, this could be going from running once per week to three times per week, or quickly increasing the durations of your runs.  Although training load is usually the trigger, there is a number of other factors that could be contributing to your ITBS, which is why a thorough examination by your Qualified Physiotherapist is important. Your Physio can identify factors like hip, knee and ankle strength, range of motion and neuromuscular control, running technique and/or foot posture that may be contributing to your presentation.

Symptoms

• Sharp or burning pain just above the outer part of the knee
• Pain increases with continuation of aggravating activity (running or other repetitive activities)
• Swelling over the outside of the knee
• Pain when bending the knee
• Gradual worsening of symptoms if left untreated

How Physiotherapy can help

You’r Qualified Physiotherapist will first diagnose your ITBS and perform an assessment to identify the causes specific to you. From there Physiotherapy rehabilitation has two stages:

Stage One – Calm it down!

In this stage, we reduce or remove irritating factors to reduce pain and inflammation. This includes identifying your symptom threshold (e.g. the time during the run, cycle or activity where you first feel pain) and then keeping your training below that level. For example, if you feel pain at 35 minutes then we keep your running to 30 minutes to stay just shy or irritating the area further.  Some people may feel pain immediately so in this case we look at activity modifications.  In this early stage we also look at addressing contributing factors such as muscle length, strength, proprioception and agility and begin a rehabilitation program targeting these. You’r Qualified Physiotherapist may also use manual therapy techniques like soft tissue release, dry needling or taping to reduce the initial pain. 

Stage Two – Build tolerance and

Once symptoms are consistently within the 0-3/10 we move onto stage two.  This stage focuses on building strength and capacity through the lower limb.  This means progressing strength exercises, and initiating a gradual return or increase in running.  This process is guided by your symptoms remaining in the 0-3/10 range.  The goal is to get you back to full training as soon as possible while preventing flare ups!

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