The word Iliotibial Band or ITB for short tends to get thrown around especially among the running community. But what exactly is it?
Iliotibial band syndrome (ITBS) is thought to be the most common cause of lateral (outside) knee pain, and yet it’s a pathology that is commonly misunderstood and under researched.
The ITB is a thick band of fascia formed proximally (top) at the hip by the fascia of the gluteus maximus, gluteus medius (your bottom muscles) and tensor fascia latae muscles. Its main functions are pelvic stabilisation and posture control.
The ITB runs along the lateral thigh and serves as an important structure involved in lower extremity motion, such as walking, hiking and running.
The ITBS has been considered in the past to be a ‘friction syndrome’ with the ITB thought to be causing friction on other structures beneath it, ultimately leading to pain. More recent research however suggests that ITB pathology is more likely to be involved in compressive forces of sensitive structures beneath instead. This change is important as it has influenced treatment which has been targeted on stretching the ITB to reduce friction and steroid injections to reduce inflammation in certain structures such as the bursa.
However……………You Can’t Stretch The ITB!
Lots of people are told to stretch your ITB, however the ITB is a strong, complex structure with multiple attachments along the femur (thigh bone) and to the knee. It provides stability for both the hip and knee joints and is thought to store and release energy like a spring. You can however stretch the structures underneath it but not the ITB directly. You also wouldn’t want to stretch it anyway as it can be a very sore area!
So what are my options?
Loss of strength and control around the hip are thought to be key in the development of ITBS, especially weakness in hip abduction and external rotation, and increased hip adduction during loading (e.g. running).
Training error is also thought to be a factor in over 60% of cases. This is where it is really important to gradually increase your sport, activities especially if this is a new hobby or even if it is something you used to do but you’ve taken a break.
Initially treatment should be aimed to first calm your symptoms down and then address the causative factors. This often comes as a progressive 3-level programme which we can help lead you through. Also, if your ITB syndrome has been present for a few months then Shockwave therapy can also be very helpful to kick start the healing process (which we offer here at Thorpes -please click here for more info)
If this sounds like a bit of you and you think or have been told you have an ITB issue or syndrome then get in touch so we can start the process of getting you back to doing the things you love! Even better, did you know if you’re a keen runner, we also ‘RUN’ a run-lab service (click here for more info).
See you soon.
Thank you for reading!
Jessica Reed (BSc, SRP, MCSP, AACP)
Specialist MSK Physiotherapist