Iliotibial band syndrome

Are you having knee problems? Knee pain is one of the most common injuries in runners and cyclists. The Iliotibial band syndrome or Iliotibial band friction syndrome as it is also called, is the most common knee problem. IT-Band syndrome causes a diffuse pain in the knee and sometimes also a painful, sharp localized discomfort nearby the knee joint.

The IT band is a tough band of tissue running along the thigh bone. It starts at the hip and ends on the shinbone, shortly beneath the knee joint. Until recently it was believed that by flexing and extending the leg, the IT band was rubbing against the thigh bone, nearby the knee joint. This rubbing would cause friction and the friction would make the Iliotibial band sore. This soreness would be the cause of the pain.

Today the researcher know, that the IT band is not rubbing at all (Fairclough et al.). The cause for the pain is pressure from the Iliotibial band on a fatty tissue, placed between the Iliotibial band and the knee joint. This tissue consists of a lot of nerves, which when stressed will give a feeling of pain. Flexuring and extending the leg build up the pressure on the fatty tissue.

With this new understanding of the biomechanics of the Iliotibial band syndrome it has become clear that to reduce the tension on the Iliotibial band you have to reduce the tension in the muscles connecting to it. That is primarily the gluteus maximus, the biggest muscle of the buttocks, and the tensor fasciae latae which is a muscle of the thigh.

You can reduce the tension through stretching and strengthening them. The stretching exercises I proposed in my last post 8 Yoga poses for removing or preventing knee pain (IT band) could help you with that.

Typical symptoms of Iliotibial band syndrome are:

* Pain just above the knee joint

* Swelling or thickening of the Iliotibial band over the lateral femoral epicondyle

* Pain at the hip (mostly elderly and pregnant)

* Diffuse pain in knee area

* Sharp localized pain at the lateral femoral epicondyle

* Clicking – it feels as if the IT band tightens and snaps across the joint

Typical causes for Iliotibial band syndrome are:

* Increasing distance too quickly

* Excessive downhill running

* Cycling with the feet toed-in to an excessive angle

* Running on a crowned surface

* Uneven leg length

* Bowlegs

* The hip abductor muscles are too weak

Typical non-surgical treatment of Iliotibial band syndrome are:

* Ice

* Stretching

* Massage

* Rest

* Hip abductor strengthening

For those of you who havent got a problem with the IT band, the following methods could help preventing it:

* Stretching (Hamstrings, gluteal muscles and quadriceps)

* Strengthening

* Gradually increasing training volume

* Avoid running downhill

* Rest

* Shorten your stride

* Correct sit position on the bike

References:

Cosca DD, et al.; Common problems in endurance athletes; Am Fam Physician. 2007 Jul 15;76(2):237-44

Devan MR, et al.; A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities; J Athl Train. 2004 Jul-Sep; 39(3): 263-267

Ellis R, et al.; Iliotibial band friction syndrome ” a systematic review; Man Ther. 2007 Aug;12(3):200-8

Fairclough J, et al.;Is iliotibial band syndrome really a friction syndrome?; J Sci Med Sport. 2007 Apr;10(2):74-6

Fairclough J, et al.; The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome; J Anat. 2006 Mar;208(3):309-16

Farrell KC, et al.; Force and repetition in cycling: possible implications for iliotibial band friction syndrome; Knee. 2003 Mar;10(1):103-9

Fredericson M, et al.;Practical management of iliotibial band friction syndrome in runners; Clin J Sport Med. 2006 May;16(3):261-8

Fredricson M, et al.; Iliotibial band syndrome in runners: innovations in treatment; Sports Med. 2005;35(5):451-9

Grau S, et al.; Hip abductor weakness is not the cause for iliotibial band syndrome; Int J Sports Med. 2008 Jul;29(7):579-83

Hamill J, et al.; A prospective study of iliotibial band strain in runners; Clin Biomech (Bristol, Avon). 2008 Oct;23(8):1018-25

Khaund R, et al.; Iliotibial band syndrome: a common source of knee pain; Am Fam Physician. 2005 Apr 15;71(8):1545-50

Miller RH, et al.; Lower extremity mechanics of iliotibial band syndrome during an exhaustive run; Gait Posture. 2007 Sep;26(3):407-13

Paluska SA; An overview of hip injuries in running; Sports Med. 2005;35(11):991-1014

Tibor LM, et al.; Differential diagnosis of pain around the hip joint; Arthroscopy. 2008 Dec;24(12):1407-21

Wanich T, et al.; Cycling injuries of the lower extremity; J Am Acad Orthop Surg. 2007 Dec;15(12):748-56

Tagged with: Exercise

Filed under: Exercise

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