Iliotibial Band Syndrome (ITBS) is a common type of running knee injury. This video and article will help you identify ITBS symptoms, causes, and treatment options.
3 Minute Video – ITBS Causes & Treatment
The Iliotibial band is a thick tendon that inserts on the outside of your knee. The function of the Iliotibial band is to help slow movement and torque at your knee during impact. Iliotibial band syndrome is a common cause of knee pain in runners. The cause is repetitive trauma to the Iliotibial band insertion on the outside of the knee resulting in tendonitis and severe lateral knee pain while running. Eventually this condition will result in degeneration of the tendon and progress to a condition called tendonosis. This means there will be excessive tightness due to abnormal scar formation and may become a source of chronic knee pain for the runner.
ITBS Symptoms and Causes
The classic sign of Iliotibial band syndrome in a runner is pain in the outside of their knee that gets progressively worse while they are running. The pain will eventually cause them to stop and may cause lasting pain that hurts worse while walking up and down stairs.
A typical runner will wait a few days until the pain is gone and try to run again with the pain often appearing again somewhere during their run. This process is repeated over again until the runner can not run over a couple of miles without severe knee pain.
Runners with very low arches and runners with very high arches are predisposed to developing Iliotibial band syndrome. Other anatomical risk factors include overpronation, anatomical leg length discrepancy, and excessive torsion at the knee, bow-legs, knock-knees and muscle imbalances. This condition is closely associated with running, therefore most runners with Iliotibial band syndrome can swim, bike, use the elliptical trainer or do free weights with no increase in pain. The condition is usually associated with an excessive increase in running mileage or duration in a new runner or an experienced runner returning from a layoff.
Examination of a runner with Iliotibial band syndrome may reveal tenderness over the outside of the knee and an increase in pain while running. A proper biomechanical evaluation should be made to check for overpronation, low arches, leg length discrepancy and other factors that may alter the runner mechanics. X-rays and MRI’s are usually not necessary although in difficult cases an MRI is warranted. Other causes of outside knee pain that must be looked for are lateral collateral ligament sprain, meniscus tears, synovial plica, runner’s knee or chondromalacia, patella tracking errors, knee bursitis and other uncommon causes such as bone tumors.
Treatment for Iliotibial band syndrome includes rest from running, strengthening of the hip and knee muscles, stretching of the hip and knee muscles, changing shoes, the use of orthotics and sometimes using an Iliotibial band compression brace. Early recognition by the runner, rest and proper treatment can result in a dramatically shortened duration of Iliotibial band syndrome. Most cases of Iliotibial band syndrome we treat get better within 4-6 weeks as opposed to 12-24 months reported by many runners!
Other forms of exercise such as biking, swimming, elliptical and weight training do not appear to aggravate Iliotibial band syndrome. It may be difficult but runner’s must stop running and allow the Iliotibial band to heal.
Changing shoes can be effective. Many runners’ report that by changing shoes their Iliotibial band syndrome was alleviated. If you currently have Iliotibial band syndrome it is probably a good idea to experiment with new running shoes. If you are currently wearing stability shoes try a neutral shoe. If you are currently wearing a neutral shoe try changing to a stability shoe or add stability over the counter orthotic.
Both over the counter orthotics and custom orthotics have been found to be superior to taking NSAID’s (non-steroidal anti-inflammatory drugs) and cortisone injections. In my experience orthotics have been useful in about 20-30% of Iliotibial band syndrome patients I have treated. Over the counter orthotics such as SUPERFEET can be useful and cost roughly $35. Sometimes custom orthotics is necessary with the cost being $327 at our clinic.
There is always typical medical treatment of plantar fasciitis. You start by taking Ibuprofen (did anyone ever tell you….Iliotibial band syndrome is an Ibuprofen deficiency?), when that does not work maybe they send you to physical therapy, (my grandma could do those exercises!), now the cortisone shot is give (man that hurt! How do you know they simply did not miss?) Then surgery is offered. Do you really want surgery and all the complications that go with it?
Here are Dr. Runco’s recommendations for ITBS:
- Get a good doctor. One who runs and specializes in manual treatment is preferable. Proper treatment will fix this condition.
- Correct training errors. This translates to “Stop running and irritating your Iliotibial band!”
- Change shoes and change your activity for the meantime from running to biking, swimming, elliptical or weights.
- Undertake a proper stretching and strengthening program, immediately.
- Get orthotics.
- Get an Iliotibial band compression strap. This will act as a “band-aid” when you return to running.
(858) 268-8525 for an appointment.
- Foam Roller – provides self massage to the IT band and can be performed at work or home. 5 minutes a day can be effective!
- SUPERFEET– Provides both and arch support while you walk and run preventing overpronation.
- Pro-tec Iliotibial band compression brace – prevents excessive strain on the IT band by providing comfortable compression.
Iliotibial Band Syndrome is probably the most common type of running knee injury that runners complain about and we see at the San Diego Running Institute. The runner usually states that they are getting “stabbing” pain in the side of their knee that prevents them from running. They will also say that the pain begins after a specific amount of mileage and disappears after they stop running.
Often runners followed advice from coaches and friends that did not work out. Icing after running and taking anti-inflammatory medication like Ibuprofen are the most common. Sometimes they tried a knee brace but it was the wrong kind. For example; many runners say they tried a knee brace and when we ask to see it they shoe us a knee brace that was intended for patella tendonitis or chondromalacia.
There are simple “quick-fixes” available at the San Diego Running Institute for Iliotibial Band Syndrome (ITBS) in addition to the runner resting and stretching. The foam roller is one running injury tool that appears to work very well for Iliotibial Band Syndrome. We will typically take a runner through the proper foam roller routine so that they get the most effective results when using it to massage their iliotibial band. Many runners also respond well to the Pro-Tec Iliotibial Band compression brace. When worn correctly, this brace can have an immediate pain relieving effect on the iliotibial band while you run.
Compression is a key component of the sports injury acronym RICE. RICE stands for Rest, Ice, Compression and Elevation. While running it is not practical to rest, ice or elevate but you can compress using the Iliotibial band compression brace. We have found the Pro-Tec brand to be superior to other compression brace brands. Some runners develop ITBS due to foot overpronation. At the San Diego Running Institute we have found SUPERFEET to be an effective over the counter sport orthotic that can help prevent overpronation and reduce torque at the knee. This in turn alleviates the pain associated with Iliotibial band Syndrome.
When these “quick fixes’ fail the San Diego Running Institute can refer you to Dr. Victor J. Runco. He is a marathon runner and running injury specialist. When the simple fixes for Iliotibial band Syndrome (ITBS) are not effective he can recommend therapy, IT-Band taping and sometimes custom foot orthotics or better shoes for the orthotics you already have. If you have knee pain or have already been diagnosed with Iliotibial band Syndrome stop by the San Diego Running Institute and let one of our running experts show you some of the easy fixes that have helped thousands of runners with this foot condition. If you prefer to make an appointment with Dr. Runco call (858) 268-8525.
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