It happens too often to many runners—you feel great and set out for an easy run, only to feel the twinge of Illiotibial Band Syndrome (ITBS) on the outside of your knee.
Iliotibial band syndrome (ITBS) or IT band syndrome for short, is an overuse injury that is common in endurance athletes like runners and bikers. It affects a tissue that runs from the side of your hip all of the way down past your knee. Most of the time, the inflammation manifests itself as pain on the outside of the knee.
The iliotibial band is the tendon attachment of hip muscles into the upper leg (tibia) just below the knee to the outer side of the front of the leg. Where the tendon passes the knee (lateral femoral condyle) there is a bursa sac between the bone and the tendon. This tendon moves over a bony bump at the outer knee as it passes in front and behind it. The bursa functions like a water balloon to reduce friction and wear of the tendon against the bony bump. In this condition, overuse causes excessive friction at this bump, resulting in inflammation and pain of the bursa (bursitis), tendon (tendinitis), or both.
Common Signs and Symptoms
Pain, tenderness, swelling, warmth, or redness over the iliotibial band at the outer knee (above the joint); may travel up or down the thigh or leg
Initially, pain at the beginning of an exercise that lessens once warmed up; eventually, pain throughout the activity, worsening as the activity continues; may cause the athlete to stop in the middle of training or competing
Pain that is worse when running down hills or stairs, on banked tracks, or next to the curb on the street
Pain that is felt most when the foot of the affected leg hits the ground
Possibly, crepitation (a crackling sound) when the tendon or bursa is moved or touched
In fact, when you first feel tightness and pain along the outside of your knee after a few miles of running, it’s common to think the problem can simply be stretched or rested away. But those suffering from IT band syndrome will find that the pain worsens if they continue until they’re no longer able to run. They will then find that they experience pain every time around the same point in the run — whether it’s 10 minutes or 30 minutes.
It’s also common for mechanical issues to contribute to IT band stress. Over-pronating or supinating as you land can stress the IT band. When fatigue sets in many runners tend to collapse their ankles or knees inward, which pulls on the band running along the outside of the leg.
Excessive pronation, leg length discrepancy, bowed legs, and lateral pelvic tilt may cause excessive stress to the Iliotibial Band. This, in turn, may cause a lateral pull on the patella, resulting in patellar subluxation as well as rubbing and irritation on the outside part of the knee.
Some observational studies have identified potential risk factors for the development of iliotibial band syndrome, including the following: preexisting iliotibial band tightness; high weekly mileage; time spent walking or running on a track; interval training; and muscular weakness of knee extensors, knee flexors, and hip abductors. Hip abductor weakness seems to contribute to the development of iliotibial band syndrome. Strengthening of the hip abductors has led to symptom improvement.
The primary initial complaint in patients with iliotibial band syndrome is diffuse pain over the lateral aspect of the knee. These patients frequently are unable to indicate one specific area of tenderness, but tend to use the palm of the hand to indicate pain over the entire lateral aspect of the knee. With time and continued activity, the initial lateral achiness progresses into a more painful, sharp, and localized discomfort over the lateral femoral epicondyle and/or the lateral tibial tubercle.
Typically, the pain begins after the completion of a run or several minutes into a run; however, as the iliotibial band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session and can even occur when the person is at rest. Patients often note that the pain is aggravated while running down hills, lengthening their stride, or sitting for long periods of time with the knee in the flexed position.
Points to Remember
The IT band doesn’t really have a discrete point of connection like most tendons, but rather blends seamlessly into the capsule around the knee … which is why your knee seems to “cinch up” during an effective iliotibial band stretch.
Most tendons have clear edges. They could be snipped at either end and then tied in a bow. They are separate from other tissues, except at the ends where they are attached to muscle and bone. The iliotibial band is simply a massive thickened section of the sausage wrapping of connective tissue that envelops the entire thigh — it is more of a reinforced section of the wrapping around the thigh than a tendon.
The ITB also manages to meet the definition for a ligament: that is, a connective tissue structure that connects bones. The ITB is partially attached to the pelvis.
Most tendons are dwarfed by the muscle they are attached to, but the iliotibial band is much more massive than the tiny tensor fasciae latae muscle — several times longer and much wider.
And although the gluteus maximus also partially uses the iliotibial band as a tendon, the connection is at an odd angle: the job of the gluteus maximus is probably not so much to pull along the length of iliotibial band, as with virtually all other muscle-tendon arrangements, but rather to increase the tension on it by pulling on it laterally, like drawing a bowstring.
Most importantly of all, it is tightly anchored the full length of the femur, from hip to knee — especially just above the knee.
Dr. Huntsman's complimentary consultations are an important aspect of the patient experience at Georgia Clinic of Chiropractic . Additionally, you can watch videos of Dr. Huntsman's patients and some of Augusta’s very own athletes describing their treatment experiences with him.
Dr. Huntsman is also one of only a handful of chiropractors in the state of Georgia that can customize your treatments with FDA approved Cold Laser Therapy.
Low-level lasers emit light in the red and infrared range. Red and infrared light penetrate deeply into human tissue, where the light energy is absorbed and turned into biochemical energy. By increasing cellular energy in the treated area, low-level laser therapy can speed healing and reduce inflammation and pain. There are no known side effects.