Wednesday, 29 May 2013

Iliotibial Band (ITB) Friction Syndrome

With the Comrades Marathon taking place this Sunday, I thought I’d write about a common injury affecting runners, namely iliotibial band (ITB) friction syndrome.

What is the Iliotibial Band?
The ITB is a band of tissue which runs from the hip, down the outside of the thigh to the knee. It is not a muscle, but continues the line of pull from the tensor fascia latae (TFL) and gluteus maximus muscles. So, when these muscles contract, there is increased tension on the ITB. The image below shows where these two muscles are in relation to the ITB.

What Causes ITB Friction Syndrome?
At the knee joint, the ITB passes over the lateral femoral epicondyle (bony piece on the outside) of the knee. As one flexes (bends) and extends (straightens) the knee, this band snaps over the lateral epicondyle. This constant rubbing aggravates the band, causing it to become inflamed. The actual bone can also become inflamed, as can the bursa, which is a fluid-filled sack separating the ITB from the lateral epicondyle. This constant friction and inflammation eventually causes pain on the outside of the knee. Weight-bearing increases the tension on the band, thus making this a common injury amongst runners.

Signs and Symptoms of ITB Friction Syndrome
The most common symptom of this condition is pain that develops only after a certain distance. This distance varies from one person to the next, but is usually the same for an individual. That is, for one runner, pain may always develop after about 6km of running. As the condition progresses, however, pain comes earlier and earlier in the run. Hills – both uphill and downhill, usually exacerbate pain. Eventually, pain is present during daily activities, such as stair climbing, as well. Point tenderness is experienced on the outside of the knee and about 2-3cm up the outside of the thigh, and is usually worse when the knee is bent to 30 degrees.

Predisposing Factors for ITB Friction Syndrome
·         Bow legs
·         Excessive foot pronation (feet fall inwards)
·         Leg-length discrepancy
·         Structural features, such as prominent bony structures at the knee joint
·         Tight TFL and gluteus muscles
·         Weak quadriceps muscle
·         Training errors, such as increasing distance too quickly, inadequate warm-up, excessive hill running, and running on the same side of a crowned road

Management of ITB Friction Syndrome
·         The acute pain and inflammation should be reduced with the use of ice, compression, elevation, nonsteroidal anti-inflammatory drugs and rest.
·         Tight and weak muscles that may be contributing to pain, such as the hip abductors and flexors, must be stretched and strengthened – this is when it is important to consult a Biokineticist who can properly assess which muscles are tight and which are weak and the appropriate exercise therapy that must be implemented to correct these imbalances.
·         Foot orthotics may be necessary to correct any structural abnormalities.
·         Running should be modified according to symptoms – avoid hills and excessive distances and build up slowly.
·         Stretching and the use of ice after a run can help manage symptoms.

ITB Friction Syndrome is a relatively easy condition to treat if it is caught early and instructions are followed regarding treatment. Most important is to take a break from running! Consult a Biokineticist for a full assessment and exercise therapy regimen if you think you may have this condition.

Reference: Anderson, M., Hall, S.J., and Martin, M. (2004). Foundations of Athletic Training: Prevention, Assessment, and Management (3rd ed.).

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