Iliotibial Band Friction Syndrome (ITBFS)
What is ITBFS?
The iliotibial (IT) band is a large band of fascia (connective tissue under the skin that encloses, stabilizes, attaches, and separates the muscles) that extends from the outside margin of the pelvis, down the outside of the leg, attaching onto the top of the tibia (below the outside of the knee) in the lower leg. The IT band, along with the muscles that attach to it, function to stabilize the knee and provide motion at the hip.
ITBFS is an overuse type injury common in runners, athletes and individuals exposed to repetitive strain type motions in the work place. Pain typically results from repetitive compression of the fat pad that sits between the IT band and the lateral knee, or from repetitive friction of the IT band where it crosses the knee.
How does ITBFS happen?
Factors that may contribute to its onset include sudden increases in volume or intensity of exercise, increase in running mileage, improper warm up before activity, muscular tightness or inflexibility, genu varum (bow-legged appearance at the knees), excessive pronation of the foot, among other sources.
What do people experience with ITBFS?
Symptoms are typically isolated to the lateral or outside portion of the knee and may include:
- Sharp pain or a dull ache which typically starts shortly after the onset of activity and may persist after stopping activity
- Muscular tightness
- Stiffness upon waking in the morning
- Pain while flexing the knee
• Too much, too soon, too fast
• Increase running mileage or training intensity too quickly can be a source of injury
• Poor running mechanics
• Activities with lateral (side-to-side) movement or sudden direction changes
• Ill-fitting or worn out footwear
• Unsupportive footwear, such as sandals or poorly structured shoes
• Uneven terrain – avoid surfaces with uneven terrain like trails or loose gravel as they may place a greater strain on the involved tissues
• High impact and high volume or intensity of exercise
• Depending on your mechanics, being overweight or obese may increase the strain on the muscles and tendons in your lower legs
• Mechanics – depending on your alignment and mechanics, you may be predisposed to IT band strain; consult with your Physiotherapist or Pedorthist if you suspect this may be the case
Options for treatment
- Family physician: first line of defence for treatment
- Physiotherapist and/ or kinesiologist: to assist with exercises, stretches or lifestyle alterations
- Pedorthist: control motions of the foot that may be impacting the strain on the IT band
- Massage therapist: to assist with muscular stiffness or discomfort
Appropriate footwear selection is important for day-to-day comfort and depends on your specific mechanics. In general, footwear with ample cushion and support work well while recovering from ITBFS. No matter which shoe you select, proper fit is vital. Length, width, depth and heel height are important considerations to make. Consult with your Pedorthist for recommendations specific to your individual foot type and intended use.
Modified ITBFS training
Staying active while you recover is important for overall health and well-being; it’s important to select appropriate exercises. As a general guideline, avoid any exercises or activities that induce or intensify your symptoms. That means both during and after the activity. With soft tissue injuries, once the tissue is warmed up it will often feel fine while active then the discomfort will set in once you stop the activity, after a period of rest, or may come the next morning when you get out of bed. If this is the case, reduce the intensity or duration of the activity until you reach a point that does not induce your symptoms. In particular, limit repetitive straining activities such as running and cycling. While recovering, chose mild intensity exercises or cross-training activities that will keep you active while helping to encourage a healthy recovery.