Understanding ITB Syndrome

What is ITB Syndrome?
Ilio-tibial Band Syndrome (ITB) is a painful musculo-skeletal condition that affects the hip and or knee and is commonly found in long distance runners. It occurs because of repetitive overuse on the outer support system of the knee.

What is the ilio-tibial band?
The ilio-tibial band is a thickened strip of connective tissue that extends from the front and outside portion of the pelvic bone down the outside portion of the thigh to the shin bone. The band originates up at the hip. As it extends down to the knee joint, the band acts as a stabilizing ligament between the high bone and the shin bone. It is a two-joint muscle that stabilizes both the knee and the hip.

How does the ilio-tibial band become injured?
This injury occurs because the band overcompensates for weakness or for some imbalance found in other major muscle groups, namely the quadricep and gluteal areas. Since the ilio-tibial band is a stabilizing unit, it helps to lock or fully extend the knee joint, which is the primary function of the quadriceps. If the quadriceps are imbalanced and weakened the ilio-tibial band starts working overtime to help stabilize the knee, keeping it extended. Therefore it becomes overused and very tight especially with a repetitive movement such as running. This chronic repetition causes friction which produces inflammation and pain in the tendon.

What are the symptoms that are typically felt with an individual that suffers from ITB Syndrome and how do you differentiate this from other painful knee or hip problems?

Usually the individual feels knee pain along the outside of the knee. The pain can extend inside as well and it is found just beneath the kneecap. There can also be groin discomfort and pain along the front of the hip area. Classically, the pain extends along the outside of the thigh and usually more toward the knee joint. This pain is normally in the distribution of the IT band where the band is found to be very taut to muscle length testing and there are numerous trigger points along the outside of the thigh. There is usually a point of exquisite pain along the outside of the knee due to the friction of the band that is rubbing against the thigh bone. You will typically see this occurring in women due to a wider pelvis, which creates a larger angle for the band to extend down to the knee joint. This overuse injury will classically be seen with athletes who put on long distance miles. Walking is usually okay, but stairs will aggravate the condition.

Treatment
For this injury, treatment is conservative and has been very encouraging. Initially, the treatment of choice is directed at reducing the irritation and inflammation, using ice for the first eight hours.

Therapeutic massage and gentle stretching for the band is recommended. In some instances local steroid injections, anti-inflammatory medications and ultrasound therapy have been helpful, but this should be used in combination with a reduction in distances run. If the individual has a hard time controlling the foot an ankle group, orthodics have sometimes proven to be effective in controlling the foot. An orthodic is a shoe insert that is used to help stabilize the foot while inside the shoe. Most often the conservative approach does prove to be effective and the time frame for symptoms to persist is usually two to six months on average. The overall prognosis is usually very good and when symptoms do reoccur with individuals, it is usually in response to a rapid change in increasing exercise level such as increasing miles run. Again it is usually a result of the repetitive motion of the knee during a sustained activity such as running.