What causes lliotibial Band Syndrome?
The iliotibial band is “ligament on the outside of the thigh extending from the hip to the lateral aspect of the knee. The iliotibial band stabilizes both the hip and the knee during the gait phase. The ligament tissue is attached at the hip through a muscle and acts as a stabilizer to the hip and knee. It resists internal rotation of the knee and can be inflamed through overuse and over-pronation. We also see ITB syndrome develop in those with very high arch feet who have minimal pronation or internal rotation of the hip. Females are more prone to this disease due to the wider hip set angle and a higher knee Q-angle (knock-knees).
What is ITBS?
liotibial band syndrome is a condition where an athlete develops pain at the insertion of the ITB at the lateral aspect of the knee or its origin at the hip. Either location can cause considerable pain and disability in an athlete. The disease is often caused by a over-pronation and internal rotation of the hip. Also, this excessive foot pronation causes internal rotation of the knee which can stress the ITB at the knee level. Weakness or substituting muscles about the hip can also cause overuse of the iliotibial band eventually leading to this disease.
Many runners will describe a “snap’ as they extend and flex the knee and/or hip and feel as if the “tendon is tearing”. This is in actuality a compression syndrome as the band of tissue passes over the knee joint (Gerdy’s tubercle) and over the the hip bone. The pain will be diagnosed by taking the knee from an extended position to a partially bent position and back to extended while placing thumb pressure over the lateral aspect of the knee (Gerdy’s tubercle). A similar maneuver can be performed at the hip.
Treatment for ITBS:
- Proper stretching techniques along with lateral hip extension exercises directed through athletic training and physical therapy.
- Nonsteroidal anti-inflammatories as directed by your physician
- Gradual warm-up exercises prior to running workout
- Ice after each workout. (Ice baths are needed on occasion)
- Cross training through cycling and swimming
- Biomechanical examination to obtain a proper diagnosis
- Functional orthotics (these may be designed to reduce pronation in most instances, however, for those unique individuals with minimal pronation and a very high arch we may need to take a different tact to increase flexibility and hip rotation)
- Specific shoes types specific to your mechanics
Tip: Dr Francis Clark researched ITB syndrome while in medical school and presented a paper on the disease and it’s treatments. He provided an early study that recognized the disease in those with cavus feet who had minimal pronation. As such, he proposed that the disease of ITBS affects those at both extreme ends of the spectrum of hip and knee rotation. As such, he is always up for a challenging ITB case and loves to get his runners back on the road.