IT band syndrome

IT Band Syndrome: A Runner’s Bane

In Lower Extremity Pains by Royce Bowman, PT, Director

One day, you’re running.

The sky looks gorgeous and you breathe deep. You use the oxygen rush to push a little harder. You run farther and faster.

As you see the end of your run in sight, you hear a pop in your knee. Your knee begins to ache and burn on the outside of your knee.

Even worse, the pain stretches up into your hip.

What’s happening?

You could be suffering from IT band syndrome.

IT band syndrome, also known as iliotibial band friction syndrome or iliotibial band syndrome, happens when your IT band starts rubbing against the outside of your knee and hip joints.

This irritating condition can cause a lot of pain, and if left untreated, can even cause permanent damage to your hips and knees.

What causes IT band syndrome? And how can you fix it? This article covers all you need to know about IT band syndrome — and how to fix it.

How does ITB affect runners and other athletes?

A strong, thick band of tissue, your iliotibial band runs down the outside of your thigh.

The band extends all the way from your pelvis to the top of your tibia.

When you bend and extend your leg, this band moves over the outer lower edge of your femur.

The IT band is made up of the tensor fasciae latae muscle which attaches to the iliotibial tract along with the gluteus maximus.

IT band tightness can lead to excessive rubbing on the femur with knee flexion and extension.

With repeated bending and knee extension, the movement may irritate the band, or nearby tissues. This friction increase can lead to inflammation and pain.

Anyone can develop iliotibial band syndrome, but it is most common in runners. Also, cyclers, swimmers, and climbers can develop the same symptoms and problems.

Iliotibial band syndrome symptomsIT band syndrome

  • Pain on the outer side of knee (may go away with exercises and return upon rest).
  • Aching.
  • Burning.
  • Warmth/Redness on outside of knee.
  • Clicking/Popping/Snapping sensation on outside of knee.
  • In severe cases, pain may radiate up or down the leg.

Tight IT band, patellar tracking and anterior knee pain

The IT band attaches to the lateral patellar retinaculum, a ligament which helps  provide stability to the patella.

When a tight IT band is present, it can lead to issues in which the patella tracks laterally during a normal quad contraction, which can result in anterior knee pain.

What causes iliotibial band tendinitis?

The pain can result directly from friction as the iliotibial band moves over the lower outer edge of the femur.

Often, this causes inflammation in the bone, tendons, and small, fluid-filled sacs (bursae) in the area. Also, the iliotibial band may abnormally compress the tissue beneath it, leading to pain.

Other causes to consider:

  • Not warming up prior to athletic activity leads to muscle tension and tight hamstrings. Both can contributing factors to IT band tendinitis.
  • Weak glutes (gluteus maximus, gluteus medius, gluteus minimus) can contribute to the IT band causing patellar misalignment.
  • Bowed legs and outward knee bend can lead to ITBS. Also, when worn out shoes lean to the outside, you risk IT band syndrome. Plus, running on uneven surfaces or downhill can cause band issues. Also, overpronation can contribute to ITBS.
  • Bad form (alignment) during exercise. 
  • Being in poor condition  puts additional strain on muscles, tendons, and joints.
  • Doing more than your body is used to. Large increases in your physical activity (running, walking, etc) can inflame your IT band.

How does ITB syndrome affect or change your gait?

As long as the IT band or surrounding tissues are inflamed, gait may be affected. When gait is affected over a long period of time, other areas of the body can be impacted leading to conditions in the back, knees, hips, or ankles.

What are long term complications of iliotibial band tendinitis?

Irritation leads to injury. Long term ITB syndrome complications can include continued pain, inability to return to physical activities, and changes in gait.

How to keep your IT band healthy

  • Warm up – stretching and a brisk walk helps your muscles (and IT band) reduces muscle tension
  • Think 10% – don’t overtrain. When you’re ready to do more, think 10%. If you’re running 10 miles and want to increase your activity, add a mile. The 10% suggestion can be applied to weekly training, whether you’re running, walking, or lifting weights. Remember, your body and muscles need time to adjust.
  • Check your shoes – if your soles show uneven wear, you need new shoes. Uneven, worn shoes contribute to knee pain.
  • Keep your knee warm – cooler seasons mean decreases in circulation and increases in muscle, tendon or joint stiffness. Keep your knee warm with a (thermal) knee brace.
  • Downhill and uneven surfaces – uneven surfaces put outward pressure on your legs. Stay on level surface when possible. Your knees will thank you.
  • Build strength – having strong glutes and hip abductor muscles go a long way in eliminating ITBS issues.
  • Stretch after exercise – as you cool down your muscles begin to stiffen. Stretching keeps your muscles and tendons limber as your activity level decreases.

How does a PT diagnose IT band syndrome?

Even with precautions and good habits, you could find yourself with IT band pain in your knee or hip.

At that point, you should seek professional help whether from your physician or a Bowman physical therapist

Your Bowman PT will diagnose IT band syndrome through:

  • the history of the condition.
  • a physical assessment.
  • measurements of ROM, strength, and special testing.

Bowman physical therapy treatments may include: stretches, strengthening exercises, manual therapy, dry needling, ice, heat, or ultrasound.

IT band pain? Get help and start your recovery

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