Knee Pain – ITB Syndrome
The Iliotibial band is a strong connective tissue that runs down the outside of the thigh originating from tensor fascia latae and gluteus maximus muscles at the pelvis and inserting into the outside of the knee onto the lateral tibial epicondyle.
During flexion and extension of the knee the band slides forwards and backwards over the femoral condyle (bony prominence on the outside of the knee). Therefore with a sudden increase in repeated motion or altered biomechanics of the lower limb this can cause excess fiction at this junction and result in knee pain known as ITB friction syndrome.
ITB friction syndrome is a very common overuse injury and occurs as a result of repeated trauma rather than a specific injury. It accounts for approximately 22% of lower extremity injuries.
Signs and symptoms include
- Sharp or burning pain on the outer aspect of the knee
- Pain that worsens during activity or running
- Occasionally swelling can occur around the outside aspect of the knee
Common Causes
- Sudden increase in activity especially running
- An increase in incline training (downhill as well as uphill)
- Poor or worn out footwear
- Altered muscle balance/biomechanics
- – Often tight quadriceps (especially vastus lateralis), TFL, adductors and sometimes gluteals
- – Often weak gluteals, core and sometimes hamstrings, post tibialis or medial quadriceps.
- Poor running technique
- – Often running with a positive crossover, excessive pronation and/or poor lateral pelvic control
Management
- Initially relative rest and reduction in training with a graded return once biomechanical factors have been addressed.
- In the short term NSAIDs may be of benefit to aid pain and inflammation
- If swelling is present ice therapy short term can help
- Proprioceptive taping
- Soft tissue release
- Dry needling
- Foam rolling
- Specific corrective stretching and strengthening exercises are essential to address the biomechanical faults identified upon assessment
- Correct footwear
- Correction of running technique
- Occasionally a corticosteroid injection can be of benefit to aid pain and inflammation locally. However, the biomechanical issues must be addressed to ensure long-term resolution of symptoms and prevent recurrence once the injection benefits wear off.
Should this sound like symptoms you are experiencing please don’t hesitate to contact our physiotherapy team, we can help to advise you appropriately and assess your biomechanics and running technique fully using our video technology.
