IT Band Syndrome

What is IT Band Syndrome?

The common street name IT Band Syndrome refers to the iliotibial band syndrome. So, what is it? Iliotibial band syndrome, or ITBS, is when the connective tissue that runs along the side of your leg from your hip bone (ilium or iliac crest) to the top of the shin bone (tibia) becomes irritated and tight from overuse that it “rubs” against the left side of the knee.

ITBS is common amongst endurance athletes like runners and cyclists. In fact, about 12% of runners and 24% of the cyclist, unfortunately, suffer from this condition. With overuse and stress, the IT band becomes so tight it causes pain on the left side of the knee, also known as the lateral side of the knee.

ITBS may be mistaken as a patellofemoral syndrome as both cause pain in and around the knee. The easy differentiator is ITBS’s symptoms area specifically on the left side of the knee, and patellofemoral pain is specifically in the front of the knee. Both are common amongst runners, cyclists, and hikers.

There is some controversy over exactly what ITBS is. For years, and still today, the medical profession believe ITBS pain is specifically located at the knee, not at the hip or thigh. The reason for this is when the tough connective tissue becomes irritated; it rubs over the side of the knee bone called the lateral epicondyle.

With new research, there is evidence the IT band may not rub against the lateral epicondyle at all, but instead, it compresses up against it, which is controversial, and more research is being done to determine what exactly causes this lateral knee pain.

What causes IT band syndrome?

There are several structures involved in ITBS including the iliotibial band, the bursa sac which helps cushion and protects against friction at the knee, and the hip muscles. ITBS develops through either repeated knee flexion (bending) and extension (straightening), or in some cases static positioning such as prolonged flexion while sitting.

There is some controversy over the exact cause of ITBS, but the most common amongst health care professional include:

  • Poor alignment from the ankle to the knee to the hip
  • Muscle imbalances at the hip and/or knee
  • Prolonged “pinching” with static or repetitive knee flexion (bending)
  • Abnormal contact of the IT band with the femur (thighbone)
  • Increased internal rotation of the tibia (shinbone)
  • Increased pronation of the foot (when the foot rolls inward)
  • Not working out for a while then overdoing it

There is some evidence that suggests weak hip abductor muscles (help you side lift your leg), and weak external rotator muscles (rotate leg and foot outward) may be a big culprit to IT band issues. When these muscles are strong and balanced, their power is meant to help stabilize the hip and knee to prevent extra and unwanted movement which may strain the IT band.

Also, when the connective tissue is compressed up against the lateral side of the knee, it does not allow for the glute muscles (buttocks) to fire properly therefore only intensifying the strain of the IT band. With weak glute muscles along with other weak abductors and external rotator muscles, this most often causes a “crossover” gait pattern which again adds stress to the IT band.

Symptoms of IT Band Syndrome

The most common symptom is a pain on the outside of the knee. Most runners will report the pain is most intense when the knee is still bent either right before, or right after, their foot hits the ground. With the knee slightly bent, this is the most common stage when the IT band rubs over the lateral side of the knee.

IT band occasionally occurs at the hip, but most often pain is at the knee. It is described as sharp, stabbing, and even stinging pain as the knee bends and extends. There may be some minor swelling at the knee.

Symptoms are the worst with such activities like running, cycling, climbing or descending stairs, and walking. Pain intensifies and continues well after the activity is done. Finally, you may also hear someone say they feel immense tightness on the lateral (outer) side of their leg between their hip and knee.

How is ITBS diagnosed?

IT band diagnosis is most often reliant upon your description of symptoms as well as with palpation. If you are experiencing pain on the left side of your knee, it is tender to touch, possibly some swelling in the area, and the pain is the worst with heel strike, then there is high likelihood you may be experiencing ITBS.

It is never recommended you self-diagnosis as the body is complicated and multiple factors come into play when determining the primary cause of your symptoms. A health care provider, such as your physical therapist, can properly assess your knee to rule out, or rule in if you have ITBS. Your PT is highly qualified and a trained professional in the differential diagnosis. He or she can quickly run through a few assessments to determine the cause of your pain.

If there is suspect of something else going on, perhaps more serious, your PT will communicate this with you and your physician. An MRI may be needed, but in most cases it is not, to help rule out any other structural injuries that may be causing your symptoms. More often than not, your PT will determine your origin of pain, and from there he or she can establish a plan.

In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

Treatment of IT Band Syndrome

The first line of treatment should be conservative. With early onset, within first 24-48 hours, it is recommended you apply RICE (rest, ice, compress, and elevate). Apply ice to the irritated area for about 15 mins per day, 2-3 times per day. Take a few days break from the activities that most irritate your symptoms. Gentle compression and elevation will aid in reducing swelling.

After a few days, up to the first week, if your symptoms are not improving or if they are worsening, it is recommended you visit with your health care provider. Your physician may recommend over-the-counter anti-inflammatories or if needed will order an MRI (magnetic resonance imaging).

The most conservative approach after the acute phase is to visit with your local physical therapist. Early diagnosis and treatment of IT band issues, will prevent a long drawn out recovery. The first goal in PT will be to reduce the inflammation and manage your symptoms.

Next, your PT will work on your form. He or she will work on muscle balance including strong glute muscles (buttocks) as well as hip rotator muscles. You will be amazed how your PT can isolate specific muscles to find your weak spot which often is the problem causing the ITBS. Even the best athletes find out because of their form it has caused muscle imbalance and gait pattern changes.

Once you’ve learned to control your gait through retraining, manual work, and strengthening, it is then your PT will slowly reintroduce functional activities. The goal is to build up your endurance without the symptoms returning.

In some cases where the inflammation is significant enough, an injection may be needed for you to tolerate your PT. An injection alone is never recommended but coupled with PT you are sure to have long-term results. Sometimes introducing an anti-inflammatory is enough to control the symptoms so you can work on proper mechanics and strengthen.

Prevention against ITBS from developing, it is recommended you manage any symptoms you are experiencing early on. The earlier you address pain and discomfort the better off you will be in the long term. Sometimes shoe inserts can help reduce foot pronation and/or if you have flat feet inserts can help support your arches. Good fitting and proper fitting running shoes are critical to prevention.

Rarely is surgery needed for this condition. Most ITBS sufferers heal with conservative care.

Next Steps

Early intervention is key to managing ITBS. The sooner you address your symptoms, the more likely conservative care will work for you. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

To get started with conservative care today, you can find a highly qualified PT in your area.   There are many qualified PTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating hip and knee pain.

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