Have you ever noticed a nagging pain on the outside of your knee? It’s hard to officially say the pain your feeling is one thing specifically, but something you should ask your doctor about is Iliotibial Band Syndrome – more commonly known as IT Band Syndrome.
What is the IT Band
The Iliotibial Band, iliotibial tract, or IT band, is not actually a tendon or muscle. The IT Band is made up of thick connective tissue, called fascia, that starts on the outside of your hip (iliac crest), down the length of your outer thigh, to the outside of your knee (at the tibia). According to an article published by the Harvard Gazette, the IT band is the largest piece of fascia in the human body.
The same article referenced above details and debates the IT band’s primary function. For years, clinicians have believed that the primary function of the iliotibial band is to help stabilize the hip when walking or running. Researchers now believe that the IT band “acts as spring to aid in locomotion runs.” In their study of human cadavers compared to chimpanzee cadavers, researchers noticed the IT band looked like another elastic structure within the human body – the Achilles tendon. They believe it “might be important in saving energy during locomotion, especially running.”
What is IT Band Syndrome
Iliotibial band syndrome, more commonly known as IT band syndrome or ITBS, is considered at overuse injury of the IT band. To better understand IT band syndrome, it is important to understand it’s function.
When you flex your knee, the IT band is located behind the femoral epicondyle, a bony protrusion, of the femur. As you move your knee into extension, or straighten it, the IT band moves forward across the bursa (a fluid filled sac) located on top of that condyle. If and when inflammation is present in this area, the IT band’s repeated rubbing against the condyle can cause pain in the knee.
When the pain and inflammation of the knee is ignored, your symptoms can become worse. As inflammation continues to increase, scarring can develop in the bursa. As the scarring develops, you may notice increased pain and decreased range of motion.
Symptoms of IT Band Syndrome
Unfortunately, many of the symptoms of IT band syndrome are similar, if not the same, as many other knee conditions.
However, the following symptoms are the most common and noticeable for those with ITBS.
Tenderness - Pressure to the outside of the knee can cause pain
Pain on the outside of the knee - Close to the femoral condyle described above
Tightness - Feeling of tightness or inflexibility of the thigh and hip
Pain at 30 degrees - “Experts theorize the IT band passes over the femoral condyle” at 30 degrees.
Who is at Risk of ITBS
Anyone can get iliotibial band syndrome, but there are a few factors that increase your chances.
Runners – As mentioned above, one of the believed functions of the IT band is to help stabilize the hip while running. Those that run long distances are then more likely to experience problems with their IT band. The surface they run on can also cause friction at the IT band (think hard surfaces).
Cyclists – Improper posture on your bike and your mechanics while riding can lead to ITBS. The location of your toe clips may lead to your foot being internally rotated or “toed in.” This, in turn, increases the amount of friction on the knee. Additionally, if your seat is too high, the increases extension while riding can irritate the knee.
Squatting athletes – This includes dancers. Because of the mechanics of a squat, your chances of the IT band rubbing over the femoral epicondyle and causing friction increase.
Anatomy – Every body is built differently. The way you are built may be a predisposition to develop IT band syndrome. Those that are bow legged, have a more extreme Q-angle (and therefor tighter IT bands), leg discrepancies, or a tilt to the pelvis can all be factors that increase your likelihood of developing ITBS.
Improper warm-ups – So many of us want to get straight to our workouts. Your body will thank you, and hopefully won’t have pain or injuries, if you take the 5-10 minutes to properly warm-up before a workout.
Activity frequency – As with most things, it’s best to slowly progress your workout regime. If you are looking to get into a specific activity or are just trying to increase your activity frequency, take your time to build up to your goal.
Footwear – Unfortunately, some of the most popular shoes aren’t the best for our bodies. What you wear on your feet has an impact on all of your joints, not just your feet and ankles. If you want to avoid injuries throughout your body, including ITBS, a supportive shoe that provides cushioning during impact is a must!
These are just some of the factors that increase your risk of iliotibial band syndrome. However, it can happen to anyone at anytime.
Treatment for ITBS There are a few different stages of treatment for iliotibial band syndrome. The first is usually people’s least favorite. Since ITBS is an overuse injury, the best thing you can do initially is rest!
Physical Therapy – Your physical therapist will be able to help you reduce inflammation, improve your flexibility and range of motion, and determine what you are doing mechanically that may be causing ITBS. They can then, also, help you modify your activities.
Targeted Rest – If you are an active individual, this may not be easy! If completing your favorite activity or daily exercise is painful, it's most likely causing further injury. Pain is a signal from your brain that something is hurt! Meet with a physical therapist to help determine what stretches or strengthening exercises you should be completing to help get you back to your favorite activities, sooner rather than later! To help decrease inflammation and irritation, you may need to take some time off, or at least reduce the frequency, of some of your favorite activities – especially running & cycling.
Ice – Ice reduces inflammation and ITBS causes inflammation. When icing, don’t ice for longer than 10-15 minutes at a time and ice AFTER activity – not before.
Anti-inflammatories – If you are unable to reduce the inflammation with ice and rest, you may choose to try an anti-inflammatory medication. This should also help reduce the pain. Be sure to consult with your physician prior to taking an medication.
Massage – Massage is great for treating ITBS for a number of reasons. Massage can work to break up any scarring that has been created by repeated friction. It can also help to reduce swelling by promoting blood flow to the area. Massage may not feel great at first in more severe cases of ITBS, but with time, should improve. If you do not have access to massage, you can also try using a foam roller. When foam rolling, stop just before the knee and just before the hip (avoid going over the joint).
Steroid Injections – When the conservative methods fail, you may be a candidate to receive a steroid injection. The steroid injection would be administered into the knee and would work to reduce the inflammation. Again, other methods such as physical therapy and rest should be (and may even be required by your insurance and/or physician) tried before an injection.
Do you think that the pain you are experiencing may be ITBS? It may be time to consult with your physician or physical therapist. Be sure to explain the things that cause you pain and what you have been doing to relieve your pain, if anything.
If you have questions about IT band syndrome or want to make an appointment with one of our physical therapists, feel free to contact us! We are happy to help you modify your routine to help eliminate your pain and work with you to stretch and strengthen the appropriate muscles! Schedule your free injury assessment & get back to it!
Peter Reuell for The Harvard Gazette, "Undestanding the IT Band," August, 26, 2015, https://news.harvard.edu/gazette/story/2015/08/understanding-the-it-band/