An Overview of IT Band Syndrome

Injury of the Iliotibial (IT) band is common among athletes

IT Band Syndrome
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Iliotibial band syndrome, or ITBS, is the result of inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins above the hip joint and extends to the outer side of the shin bone (tibia) just below the knee joint. The IT band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint.

Symptoms

As stated previously, the function of the iliotibial band is both to provide stability to the knee and to assist in bending the knee joint. When irritated, the movement of the knee joint becomes painful. Usually, the pain worsens with repetitive movements and resolves with rest. Common symptoms of ITBS include:

  • Pain over the outside of the knee joint
  • Swelling at the location of discomfort
  • A snapping or popping sensation as the knee is bent

It is estimated that between 5% and 14% of endurance athletes experience ITBS at some point in their careers. Athletes who suddenly increase their intensity levels, such as runners wanting to beat their current pace, are especially vulnerable.

Causes

Iliotibial band syndrome (ITBS) occurs when there is an irritation to this band of fibrous tissue. The irritation usually occurs at the prominence of the outside of the knee joint, the lateral condyle which is located at the end of the femur (thigh) bone.

The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion of the band. When inflamed, the iliotibial band does not glide easily, causing pain with movement.

Iliotibial band inflammation is often caused by the repetitive bending of the knee during physical activities such as running, cycling, swimming, or climbing. 

According to a 2013 review in the Journal of Sports Medicine, the risk factors for ITBS include pre-existing IT band tightness, high weekly mileage, interval training, the lack of sufficient pre-exercise warm-up, and weakness of knee extensor, knee flexor, and hip abductor muscles.

Treatment

The treatment of iliotibial syndrome involves early-stage acute care followed by the sub-acute and chronic phases of treatment.

Acute Phase

Treatment of iliotibial band syndrome begins with efforts to control the inflammation. The initial phase is:

  • Rest: The first step to allowing the inflammation to subside is to allow the joint to rest sufficiently. Athletes should avoid activities that cause worsening of symptoms. Often athletes can find a cross-training alternative activity that does not cause persistence of the symptoms.
  • Ice application: Icing the area of discomfort can help to relieve the pain and settle the inflammation. It is important to apply ice frequently and consistently. Especially after activity, ice can help to minimize swelling.
  • Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently recommended to help relieve inflammation about the iliotibial band. Before beginning any anti-inflammatory medication one should discuss with their healthcare provider the safety of these medications.

Once the acute symptoms have subsided, a rehabilitation program may be needed under the supervision of a physical therapist. According to a 2013 review in Topics in Integrative Health Care, the only recommended exercise for people with ITBS is swimming using only the arms with a pool buoy between the legs.

Sub-Acute and Chronic Phase

Once the acute symptoms are controlled, patients should make efforts to increase the flexibility and strength of the hip and knee. Most rehabilitation protocols focus on both hip and knee function, as the iliotibial band requires proper mechanics of both of these joints for normal function.

As hip and knee function improves, rehab will shift from sub-acute therapies to chronic therapies that exert weight-bearing stress on the joints.

Working with a physical therapist can help you ensure you are developing an appropriate treatment strategy. Runners, cyclists, and other endurance athletes should find cross-training techniques that allow maintenance of their endurance without the continuation of their discomfort.

A cortisone injection can also help alleviate inflammation, although it is generally reserved for when all other treatment options have failed.

In young athletes, most physicians agree that cortisone is probably not a good solution for IT band syndrome. Certainly, cortisone should not be injected so that young athletes can continue playing sports

If all else fails, surgery is an option but only in very rare circumstances. In these situations, the IT band can be surgically lengthened to allow less friction over the structures on the outside of the knee joint.

There are differing opinions as to when surgery should be considered. Some practitioners recommend no less than nine months of conservative therapy before the discussion is even broached. Though surgery is considered the last-resort option for ITBS, research suggests that the majority of procedures are successful.

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Article Sources

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  2. Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. J Sports Med (Hindawi Publ Corp). 2013;2013:367169. doi:10.1155/2013/367169

  3. Saikia S, Tepe R. Etiology, treatment, and prevention of ITB syndrome: a literature review. Topics Integ Health Care. 2013;4(3):4.3004.