Iliotibial Band Syndrome

What is it?

The IT (Iliotibial) band is a tough band of fibrous tissue that runs down the outside of the thigh. The upper fibers of the IT band start at the hip and the lower fibers insert below the knee on the outside of the tibia (shin bone). It works with the surrounding muscles to assist in flexion and stabilization of the knee. It also assists with hip movements out to the side and internal rotation. IT band syndrome is an irritation of this tissue due to excessive tightening or shortening of the band. It is commonly felt as localized pain on the lower thigh or outside of the knee where the IT band inserts. It may also be painful at any point along its length. A tight IT band is often the cause of greater trochanteric bursitis (at the prominent knob of the hip bone). Pain can be aggravated by activities such as running, climbing and descending stairs, or getting out of a car. Pain is usually worse during activity and can lessen during rest. This is because activity tends to promote more tightening of the band and more friction over the bony prominences the band crosses.

How did I get it?

There are many anatomical factors that can contribute to the development of this condition. People with bowed legs, excessive internal rotation of the lower leg, pelvic muscle imbalances and leg length differences may be prone to developing this problem. This is a repetitive stress injury so excessive training, or always running on the same side of a curved road is thought to contribute to IT band syndrome. Biomechanical problems in the feet are also a major contributor to the development of this syndrome. Specifically, excessive pronation or flattening of the arches can lead to extra stresses on the outside of the knee and thigh. When the feet flatten, the lower leg is turned inwards (internal rotation). This moves up the chain to rotate the thigh inwards. This creates a bowing of the knee and added strain on the outside of the knee. When running or moving on flattened arches, the tightened IT band may rub over bones in the hip or knee or just get irritable from the tightness, triggering inflammation and pain.

How is it treated?

Exercise:

Stretching exercises are directed at lengthening the IT band and the muscles of the outside of the hip, to try and relieve some of the tightness. Strengthening exercises can be directed at the gluteal region to stabilize the pelvis and try to prevent pulling of the IT band at the knee. Remember, the IT band is not a muscle, but a thick band of fibrous tissue (think of a tough piece of leather) so it is very resistant to being stretched.

Anti-Inflammatory Agents:

These may include ice and oral anti-inflammatory medications. Ice can be applied directly to the site of pain to decrease the inflammatory response. These may provide some temporary relief from the pain of inflammation, but are not helpful in addressing the underlying cause of the condition.

Rest and/or Training modification:

Rest is often recommended to reduce inflammation. It may be advised to decrease training time or distance. It may also be advised to avoid activities such as running and try biking or swimming. Altered or reduced training schedules may be suggested in combination with running form advice. Shortening your stride and avoiding hills may be part of the strategy. It is important to remember that although rest by itself may decrease your pain temporarily, it does not address the reason why this problem has developed this in the first place.

Steroid Injections:

A local cortisone injection to the side of inflammation can help temporarily reduce the pain of IT Band syndrome. This is a last resort and only done when all other treatments have failed.

Custom Foot Orthotics:

Custom made CBAS foot orthotics can address knee pain that is, at least partially, caused by poor biomechanical problems of the feet, specifically excessive pronation or flattening of the arches.

CBAS unlike typical custom orthotics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it. Only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This restoration of proper foot function takes the abnormal joint positions and stresses off of the knee minimizing harmful compressive forces that cause knee injury therefore allowing the affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics not only help with the body’s posture of the lower kinetic chain, but it may provide the difference for long-term success in the management of knee pain.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.