Iliotibial Band Syndrome

The following article is a guide to the treatment and prevention of knee pain and knee injury caused by iliotibial band syndrome.

Knee Pain, Knee Injuries, and Iliotibial Band Syndrome

A major cause of knee pain and knee injuries is iliotibial (IT) band syndrome, which not only puts a big strain on the knee but also on the hip joints. Let's start by looking at the muscle responsible for the problem.

The iliotibial band is a thick tendon-like portion of a muscle called the tensor fasciae latae, located on the side of the hip. The tendon of the tensor fasciae latae, called the iliotibial (IT) band, passes down the outside of the thigh and attaches to the bone just below the knee.

The diagram to the right shows the anterior (front) view of the right thigh muscles. If you look towards the top left of the diagram, you'll see the tensor fasciae latae muscle. Follow the tendon of this muscle down and you'll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band, or iliotibial tract as it is labelled in the diagram.

The main problem occurs when the tensor fasciae latae muscle and iliotibial band become tight. This causes the tendon to pull the knee joint out of alignment, which results in inflammation and pain.

Causes

The two main causes of iliotibial band syndrome and the associated knee pain are overload and biomechanical errors.

Overload is common with sports that require a lot of running or weight bearing activity, which is why iliotibial band syndrome is a common runner's injury. When the tensor fasciae latae muscle and iliotibial band become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in-turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.

Overload on the IT band can be caused by a number of things, including

• exercising on hard surfaces, such as concrete;
• exercising on uneven ground;
• beginning an exercise program after a long lay-off;
• increasing exercise intensity or duration too quickly;
• exercising in worn out or ill fitting shoes; and
• excessive uphill or downhill running.

Biomechanical errors include

• leg length differences;
• tight, stiff muscles in the leg;
• muscle imbalances;
• foot structure problems such as flat feet; and
• gait or running style problems such as pronation.

Immediate Treatment

First, whether it is an overload problem, or a biomechanical problem, be sure to remove the cause of the problem. You will likely need professional help to determine the cause.

The basic treatment for knee pain that results from IT band syndrome is no different from most other soft tissue injuries. Immediately following the onset of any knee pain, use the R.I.C.E.R. regime. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

Ongoing Treatment and Prevention

Although you may feel the pain mainly in the knee, the problem is caused by the muscles that support the knee, namely the tensor fasciae latae and the large butt muscle called the gluteus maximus.

Other muscles in the lower back, hip, butt, and upper leg also affect the function of the knee, so it's important to pay attention to all these muscles. After the first 48 to 72 hours, consider a good deep tissue massage. It may be just what you need to help loosen up those tight muscles.

First, a thorough and correct warm up will help prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons are tight and stiff, with limited blood flow to the leg muscles, which results in a lack of oxygen and nutrients for those muscles.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity. Click here for a detailed explanation of how, why, and when to perform your warm up.

Second, flexible muscles are important in the prevention of most leg injuries. When muscles and tendons are flexible and supple, they can move and perform without being over stretched. If, however, your muscles and tendons are tight and stiff, it is easy to push those muscles and tendons beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

The stretch to the right is one of the best stretches for the tensor fasciae latae.

Stand upright and cross one foot behind the other. Then lean towards the rear foot. Hold this stretch for about 15 to 20 seconds, and then repeat it 3 to 4 times on each leg.

For an easy-to-use, quick reference guide of 135 clear photographs of every possible stretching exercise, for every major muscle group in your body, get a copy of The Stretching Handbook. You'll also learn the benefits of flexibility, the rules for safe stretching, and how to stretch properly.

Third, strengthening and conditioning the muscles around your knee and upper leg will help greatly reduce the chance of knee injury and knee pain.

If you are in too much pain to resume normal exercise, consider swimming, deep water exercise, or maybe cycling. Otherwise, see these Exercises for Knee Strength and Flexibility.