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ITB Syndrome Treatment Physio Penrith

Treatment of ITB Syndrome at Sydney Muscle & Joint Physio Penrith

What is ITB syndrome?

Iliotibial band (ITB) syndrome is a common knee injury in runners and other long distance athletes caused by inflammation of the distal portion of the iliotibial band (ITB), which results in lateral knee pain or pain on the outisde of the knee joint. The distal part of the iliotibial band slides over a bony prominence called the lateral femoral epicondyle, and during repetitive knee bending and straightening activities there can be excessive friction and this potential irritation results in pain.

More recent literature is shedding a different light on ITB syndrome - one that describes the iT band as a big tendon (even though it is actually a ligament), thus making it an interesting injury to assess and treat:

  • In a 2007 study the authors found that the ITB blended with the connective tissue wrappings of the thigh and the knee joint capsule. It is also quite well-connected with many discrete deep attachment points (“insertions”) on the femur, the tibia, and the patella.

  • The IT band is tightly anchored to the full length of the femur, from hip to knee - especially just above the knee.

  • The upper reaches of the IT band also penetrate all the way into the hip, from the bottom of the TFL muscle to the lateral surface of the hip joint - this feature of the IT band was first clarified in 2017. The feature has no direct relevance to IT band syndrome, but it’s interesting anatomy that’s really at odds with the conventional picture of the IT band as a superficial strap running down the outside of the thigh.

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Most people still think of the IT band as being free to move relative to the femur, but the iliotibial band is not free to move relative to the femur. It is anchored to the femur between the big muscles of the front and back; it clings to it like a barnacle to a rock, this is why it has been suggested that “the ITB cannot actually create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee".

What are the symptoms of ITB syndrome?

People with with ITB syndrome will have typical symptoms that include a sharp or burning pain roughly 2 cm above the lateral joint line. The pain may radiate proximally or distally, and in less severe cases, the pain may quickly subside upon cessation of activities. Often pain will occur as activities proceed. It is not uncommon that individuals will experience popping on the lateral aspect of the knee with activities. Potential risk factors for the development of iliotibial band syndrome include preexisting iliotibial band tightness, high weekly mileage, time spent walking or running on a track, interval training, and muscular weakness of knee extensors, flexors, and hip abductors.

How do you diagnose ITB syndrome?

ITB syndrome is a clinical diagnosis and is best concluded during a thorough history. Most often additional diagnostic tests and imaging are not necessary. It should be suspected in overuse and non-traumatic cases of knee pain where rest has not been helpful. Short-term resolution of symptoms following corticosteroid injection and be both diagnostic and therapeutic.

At Sydney Muscle & Joint Clinic our physiotherapists listen for typical signs and symptoms that are related to a tendon injury, these may any of the following related to ITB syndrome:

  • localised pain - demonstrated when the individual can point to where it hurts.

  • start up pain - sharp stabbing pain about the outside of the knee when rising from a chair or getting out of bed. The start up pain improves as movement continues.

  • pain on compression - pressing down on the area, foam rolling or lying on ones side can all irritate a painful IT band.

  • weakness of muscles that are part of the ITB - weakness of hip abductors, lateral hamstrings and quadriceps is very apparent.

Treatment of ITB syndrome?

As the iliotibial band is usually described as a tendon, the research supported interventions for tendon injuries should be applied to anyone suffering from ITB syndrome. These include:

  • Nil rest - rest does not help a painful IT band

  • Modify training load - slightly reducing your running mileage or reducing frequency of other ballistic loading may be necessary in the short-term.

  • Nil stretching - stretching is not helpful and can cause compression of the irritable tendon (IT band).

  • Nil foam rolling - as with stretching, foam rolling can cause compressive, irritable load.

  • Add heavy slow resistance exercises - to the muscles of the hip including gluteus medius, minimus and maximus; lateral hamstrings and soleus.

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