Iliotibial Band Syndrome

Spring has sprung early and beautifully this year. We can’t have the yin without the yang it seems, so along with early warmth, blue skies, and breathtaking buds comes allergies, knee, hip, and low back conditions. Just like allergies, musculoskeletal conditions come any time of year, but each season seems to bring more of one than the other. Spring and summer see a lot of knee conditions, but iliotibial band syndrome (ITB) is the unquestioned champion of Soarbody Therapeutics at this time of year.

A syndrome is distinct from a disease or specific condition in that is defined by the presence of a number of symptoms that characterize a condition and its usually ongoing, that is, it doesn’t run a specific course with an outcome. Generally, ITB syndrome is an overuse syndrome whose main symptom, pain at the lateral aspect of the knee, is caused by friction between the lateral epicondyle of the femur and the iliotibial band. So let’s step back and see what that means.

The iliotibial band is a tough band of connective tissue connects two muscles whose origin are on the ilium (gluteus maximus and tensor fasciae latae, TFL) to the anterior of the tibia, specifically to a lump on the more anterior aspect of the tibia called Gerdy’s Tubercle. Because of the way the ITB has to angle past the knee to get to the anterolateral aspect of the Tibia, it has to pass by the lateral epicondyle of the femur. When running, as gluteus maximus and TFL are engaged during heel strike phase to stabilize the leg and ready the hip for extension and the knee for flexion, great pressure is felt along the ITB. The ITB has to pass over the lateral epicondyle as the knee moves from being fully extended into flexion while still under great stress from gluteus maximus and TFL. It’s believed that that most of the friction takes place around 30 degrees of knee flexion. Although by no means restricted to runners, this scenario is played out most dramatically in distance runners.

So why don’t all runners experience this syndrome? Because there are a number of variables involved in how forcefully the ITB snaps over the lateral epicondyle. Training errors (scheduling too much distance, too much downhill too soon) are certainly one cause. Certain inherent traits are also factors (Q – angle, arch design and mechanics in the foot). The most frequent cause of stubborn cases of ITB syndrome in this therapist’s experience, however, is simply the over use of the muscles recruited to perform the athletes’ main action combined with the under utilization of other muscles that are usually used to provide stability in gait. This overuse may be due to training error or compensational patterns due to previous injuries.

In the case of ITB syndrome, over use of gluteus maximus and TFL and under utilization in the gluteus minimus and medius are often implicated as active structures in the hip to be addressed. However, keep in mind that imbalances to either side of the knee, proximal and distal, can present unbalanced stresses around the knee in gait. So a good therapist will be examining what is happening distal to the knee in the leg, ankle, and foot as well as what is occurring in the thigh and hip. Manual therapists, in fact, often neglect to address both the muscles of the leg (especially the peronials!) and adjustments to the ankle (be on the look-out for this error!).

Finally, be mindful of the stages of healing (see the last post). Chronic overuse injuries often come to those of us (myself included) who are crazed about having to do our sport. In fact, in all honesty, many of us get injured because we have been obsessively practicing our sport without giving our bodies a break to heal (no post season). You need to follow the therapist’s directives. No running means no running! You’ll survive, believe me. Cheating will just impede your progress. For those of you who are running to maintain your weight, there are better ways to do it (cardio is not the best, by the way) and a personal trainer or strength coach who can communicate with your therapist can help you maintain your ideal weight. If you are running to fight off depression, talk to a psychologist about other means of control while you are healing