One of the most common causes of knee pain, especially in people participating in endurance sports, is Iliotibial Band Syndrome (IT Band Syndrome). It accounts for up to 24% of cycling injuries and up to 12% of running injuries. Physical Therapy is extremely effective in managing Iliotibial Band Syndrome.
What Exactly Is Iliotibial Band Syndrome?
The Iliotibial Band (often referred to as the IT Band) is a type of soft tissue that runs along the outside of the thigh from the pelvis to the knee. Its shape thickens as it approaches the knee as it crosses a prominent area of the femur (thigh bone) called the lateral femoral condyle. It attaches to two important hip muscles near the pelvis–the gluteus maximus and the tensor fascia latae (TFL). Iliotibial Band Syndrome occurs when excessive irritation causes pain along the outside of the knee.
When an individual moves through repetitive extension (straightening) and flexion (bending) of the knee, irritation and inflammation arise from friction between the Iliotibial Band and underlying structures. Typically, pain occurs from Iliotibial Band Syndrome with overuse during activities such as running and bicycling. Discomfort most notably arises from:
- Poor alignment and/or muscular control of the lower body
- Abnormal contact between the Iliotibial Band and the femur (thigh bone)
- Prolonged pinching (compression) or rubbing (shearing) forces during repetitive activities
The common structures in Iliotibial Band Syndrome are:
- Iliotibial Band
- Hip muscles
- Bursa (fluid-filled sac that sits between soft tissue and bone to reduce friction)
Iliotibial Band Syndrome can occur in:
- Individuals who quickly start a new exercise regimen without proper warm-up or preparation
- Athletes performing repetitive activities (such as squatting) and endurance sports such as running and cycling
- Individuals who spend excessive amounts of time in prolonged positions (such as sitting or standing for a long work day, climbing or squatting, or kneeling)
What Does Iliotibial Band Syndrome Feel Like?
Common symptoms associated with Iliotibial Band Syndrome include:
- Sharp, stabbing (or stinging) pain along the outside of the knee
- Swelling along the outside of your knee
- A “snapping” sensation on the outside of the knee as it bends and straightens
- Occasional tightness and pain along the outside of the hip
- Prolonged pain following activity, especially with walking, climbing, descending stairs, or going from a seated to a standing position
Pain is normally greatest when the knee is slightly bent, either right before or right after the foot hits the ground (this is the point where the Iliotibial Band rubs the most over the femur (thigh bone).
How Is Iliotibial Band Syndrome Diagnosed?
Your Physical Therapist should be able to diagnose whether you do, in fact, have Iliotibial Band Syndrome. Once they ask you about your activity regimen and medical history, they should perform a thorough physical evaluation to measure range of motion, strength, and flexibility at the hip, knee, and ankle. They most likely will also conduct specific tests and complete a movement analysis, looking for abnormal movement patterns that may be contributing to your symptoms. This assessment could include walking/running mechanics, foot structure, and balance. If you are an athlete, then your Physical Therapist should want to know specifics about your chosen sport, including footwear, exercise routine, and training routes. Medical imaging tests such as X-rays and MRIs are not typically needed to confirm a diagnosis of Iliotibial Band Syndrome.
How Can Physical Therapy Help?
Your Physical Therapist should use treatment strategies to focus on :
Manual Therapy–Hands-on treatment techniques such as soft tissue massage, joint mobilization, and muscle energy techniques can help regain range of motion and strength by targeting areas that are often difficult for you to treat on your own.
Range of Motion–Your Physical Therapist should assess the motion of your injured leg compared with normal motion of your hip, knee, and ankle of your “good” leg, since abnormal motion of the hip, knee, and ankle can cause Iliotibial Band Syndrome.
Muscle Strength–Weakness of your hip and core can contribute to Iliotibial Band Syndrome (your core refers to the muscles of your pelvis, lower back, and abdomen). For athletes performing endurance sports, it is very important to have a strong core in order to stabilize the hip and knee joints during repetitive leg motions. Your Physical Therapist should be able to provide specific exercises to target weak muscles.
Functional Training–It is extremely important to realize that, even after you regain normal range of motion and strength, your body must be instructed in how to perform controlled and coordinated movements to eliminate excessive stress at the previously injured structures. Your Physical Therapist should create exercises specific to your desired activity and treatment goals that will replicate your activities and challenge your body to learn the correct way to move.
Can Iliotibial Band Syndrome Be Prevented?
The best way to prevent Iliotibial Band Syndrome is to maintain core and lower extremity strength and flexibility and to monitor your activity. It is extremely important to modify your activity and to contact your Physical Therapist at the onset of discomfort. Research has shown that when soft tissue is irritated and the offending activity persists, the body does not have time to repair the injured area. This quite often leads to persistent pain, and the longer you wait, the more difficult the condition becomes to resolve. Once you are involved in a rehabilitation program your Physical Therapist will help you to determine when you are ready to progress back to your prior level of function. They should make certain that your body is ready to handle the rigors and demands of your activities so that your injury does not reoccur. You should also be provided with an extremely critical home exercise program to help you maintain the improvements that you gained during your rehab.
If you or someone you know has the signs and symptoms of Iliotibial Band Syndrome don’t delay–call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t wait–schedule now!