ITB syndrome

What is ITB syndrome?

ITB Syndrome (Iliotibial Band Syndrome) is an overuse injury affecting the iliotibial band, a thick band of connective tissue that runs along the outside of the thigh, from the hip to the shin. It’s common in runners, cyclists, and athletes who perform repetitive knee movements.

Mechanism of Injury:

ITB Syndrome is typically caused by repetitive friction of the iliotibial band over the lateral femoral epicondyle (the outer part of the knee), such as:

Repetitive Knee Flexion and Extension: Activities like running, cycling, or hiking, which involve repeated bending and straightening of the knee, can irritate the IT band.
Overuse: High mileage or intense training without adequate rest can lead to inflammation and irritation of the IT band.
Poor Running Mechanics: Issues such as overpronation, a tight IT band, or weak hip abductors can alter movement patterns, increasing strain on the IT band.
Downhill Running: Running downhill places extra stress on the IT band as it works to stabilise the knee.
Improper Footwear: Wearing shoes that don’t provide adequate support can exacerbate the problem by altering gait mechanics.

Symptoms

Pain on the Outside of the Knee: The primary symptom is a sharp or burning pain on the lateral (outer) side of the knee, typically where the IT band crosses the knee joint.
Pain During Activity: Discomfort usually begins during exercise, especially activities involving repetitive knee flexion and extension, such as running or cycling. The pain often worsens with continued activity.
Tenderness: The area on the outer side of the knee may be tender to the touch.
Swelling: Mild swelling or thickening of the IT band may be present near the knee.
Snapping Sensation: Some individuals may feel or hear a snapping or popping sensation as the IT band moves over the knee during activity.
Pain with Downhill Running or Stairs: Pain is often aggravated by running downhill or going down stairs, as these activities increase stress on the IT band.

Treatment

Clinical Treatment:

Assessment: A physical examination to identify contributing factors, such as muscle imbalances or biomechanical issues. Gait analysis may also be conducted to evaluate running or walking patterns.
Physical Therapy: A comprehensive program focusing on stretching the IT band, strengthening the hip abductors and glutes, and improving flexibility in the hips and thighs.
Activity Modification: Reducing or avoiding activities that aggravate the IT band, with gradual reintroduction once pain subsides.
Stretching Exercises: Specific stretches for the IT band, quadriceps, hamstrings, and hip flexors to reduce tension on the IT band.
Foam Rolling: Using a foam roller to massage and release tension in the IT band and surrounding muscles.
Bracing or Taping: In some cases, a knee brace or taping technique may be used to provide support and reduce friction during activity.
Dry Needling: Targeted to relieve tension and trigger points in the IT band and associated muscles.
Ultrasound Therapy: Applied to the lateral knee and IT band to reduce inflammation and promote tissue healing.
Massage: Focused on the IT band, quadriceps, and glutes to relieve tightness and improve flexibility.
Hot Stones: Used to relax tight muscles and provide pain relief.
Cupping: Enhances blood flow to the affected area, helping to reduce muscle tension and support healing.
Rehabilitation Plan: Includes a gradual return to activity with a focus on correcting running mechanics, strengthening the hip and glute muscles, and maintaining flexibility in the IT band and surrounding areas.