Iliotibial band syndrome (ITBS) is a common running injury characterized by outer knee pain, frequently experienced by runners.
The IT band is a band of connective tissue that runs from the hip bone to the knee. This syndrome typically arises from excessive friction or irritation of the band.
Repetitive motions during activities like running, cycling, or climbing stairs can cause the IT band to rub against surrounding structures, leading to pain over time.
As Dr. Utku Erdem Özer, I specialize in diagnosing and treating IT band syndrome, offering effective solutions to my patients.
Iliotibial (IT) Band Syndrome
Iliotibial band syndrome, also known as IT band friction syndrome, is a condition that causes pain on the outer side of the knee. It is most common in athletes, particularly runners and cyclists.
The IT band originates from the pelvis and travels over the bony prominence of the hip (greater trochanter).
It extends down along the outer side of the thigh, passing over the outer knee (lateral femoral condyle) and attaching to a bony prominence just below the knee joint on the tibia (Gerdy’s tubercle). This strong, thick, and long connective tissue is one of the most challenging structures to stretch in the human body.
The most painful area in IT band syndrome is where the band passes over the bony structure on the outer side of the knee joint (the lateral femoral condyle). The second most common site of pain is the outer side of the hip joint, where it passes over the greater trochanter of the femur.
When you bend and straighten your leg, the IT band moves over the outer lower edge of your thigh bone. In runners and cyclists, the repetitive bending and straightening of the knee can cause this movement of the IT band to irritate nearby tissues, resulting in pain.
What Causes Iliotibial (IT) Band Syndrome?
While the exact cause of iliotibial band syndrome is debated, we know that it is often shortened in most athletes. This shortening is usually due to weakness in the hip muscles. These muscles include the gluteus maximus, medius, and minimus. Weakness in these muscles means they are not bearing the weight of the body as it is transmitted downwards. As a result, this weight must be carried and transmitted to the ground somehow. Here, our structure called the IT band takes on this task, albeit involuntarily. Over time, the IT band carrying the extra weight becomes stronger and shorter. As it shortens, it rubs against the bony structure on the outer part of the knee, causing pain.
The pain is caused by direct friction as the IT band moves over the outer lower edge of the thigh bone. This leads to inflammation (bursitis) in the bone, tendons, and small fluid-filled sacs (bursae) in the area.
What Causes Iliotibial (IT) Band Syndrome?
Although the exact cause of IT band syndrome is still debated, it is commonly observed that the IT band is shortened in most athletes. This shortening is often due to weakness in the hip muscles, including the gluteus maximus, medius, and minimus.
Weak hip muscles fail to bear the load of the body effectively, leading to the IT band compensating for this burden. Over time, the IT band becomes tighter and shorter, eventually rubbing against the outer bony structures of the knee, causing pain.
The pain results from direct friction as the IT band moves over the lower outer edge of the thigh bone. This friction can lead to inflammation in the bone, tendons, and small fluid-filled sacs (bursae), resulting in bursitis.
Who Is at Risk for Iliotibial (IT) Band Syndrome?
IT band syndrome is most commonly seen in runners but can also affect cyclists, skiers, rowers, and soccer players.
As a runner, your risk of developing IT band syndrome increases in the following situations:
Running on uneven or downhill terrain.
Running with worn-out shoes.
Increasing your weekly mileage by more than 15% suddenly.
Having bowleg deformity (genu varum).
Running in cold weather.
What Are the Symptoms of Iliotibial (IT) Band Syndrome?
IT band syndrome causes pain on the outer side of the knee. It can affect one or both knees. In some cases, the pain starts at the knee and radiates along the thigh to the hip, sometimes accompanied by a burning sensation.
The pain typically occurs only during exercise, especially running, and is not usually present at rest. Pain is most intense immediately after your foot strikes the ground while running. It often begins after the third or fourth kilometer of a run but may also appear toward the end of a training session.
As IT band pain becomes chronic, it may start earlier during runs and persist into daily activities, even after stopping the activity. Activities like walking uphill or downhill and climbing stairs can worsen the pain.
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How Is Iliotibial (IT) Band Syndrome Diagnosed?
Diagnosing IT band syndrome is straightforward following a thorough physical examination. During the examination, the range of motion, strength, and pain points in the knee are assessed.
IT band syndrome is often mistaken for a lateral meniscus tear since the pain locations are almost identical. If the diagnosis is unclear, imaging techniques like X-rays or MRIs may be used to rule out other potential causes.
How Is Iliotibial Band Syndrome Treated?
Treatment begins with ice therapy and pain relievers prescribed by your doctor.
The treatment focuses on two main areas:
Strengthening: Strengthening the hip stabilizer muscles, including the gluteus maximus, medius, and minimus.
Stretching: Stretching the iliotibial band to improve its flexibility.
Stretching the Iliotibial Band
It is important to note that the iliotibial (IT) band is one of the most challenging structures in the body to stretch. There is no universal method for stretching the IT band—it varies from person to person.
Based on my personal experience, I have seen excellent results from this specific stretch, both for myself and my patients. However, if you do not see results from performing this exercise yourself, working with an experienced sports physiotherapist can be more beneficial.
For cyclists, IT band issues often stem from improper bike fit. Common problems include incorrect saddle height or improper adjustment of clip-in pedals and shoes.
Can IT Band Syndrome Be Treated with Physical Therapy?
Physical therapy performed in hospitals is often less effective for patients with IT band syndrome. Instead, personalized and targeted exercises are recommended.
How to Stretch the Iliotibial Band?
The IT band is one of the most challenging structures to stretch. As an athlete who has personally experienced IT band issues, I have shared a video demonstrating the stretch that resolved my problem. You can watch it by clicking this link:
Watch the video several times to fully understand how to perform the IT band stretch.
When performing the stretch, you should feel pain in the IT band area of your knee—this indicates you are doing the exercise correctly.
Many athletes may struggle with this stretch due to limited hip mobility. To perform it correctly, focus first on mobilizing your hip joint and increasing its range of motion.
If you feel pain during a run or workout, you can perform this stretch even while seated on the ground. You will likely experience significant relief as long as the exercise is done correctly.
Is IT Band Syndrome Treated with Surgery?
The majority of athletes with IT band syndrome benefit from the treatments mentioned above. However, if your pain persists despite following these treatments under medical supervision, surgical options may be considered.
Surgical techniques include Z-shaped cutting to lengthen the IT band or removing the part of the band that moves over the lateral femoral condyle. Most patients requiring surgery have significant thickening or fibrosis in the IT band or inflammation in the bursa at the lateral femoral condyle. If surgery is planned, these problematic tissues are removed.
Can IT Band Syndrome Be Prevented? What Can I Do?
In most cases, IT band syndrome is preventable. Follow these tips:
Train on flat surfaces until your body adapts to the activity.
Replace your running shoes regularly (every 600-800 km).
When running on a circular track, alternate directions to balance the load on both legs.
Include strength training exercises for the core, hips, quadriceps, hamstrings, calves, and feet in your workout routine.
Dedicate at least two days a week to stretching sessions lasting 30-45 minutes.
If you are new to running, start gradually and increase your mileage incrementally.
IT Band Syndrome Exercises
IT Band Stretch: Stand and cross one foot over the other, then lean your body to the side to stretch the opposite IT band.
Glute and Hip Strengthening: Exercises like squats, lunges, and hip abduction movements to strengthen the glutes and hip muscles.
Stretching Leg Muscles: Focus on stretching the quadriceps, hamstrings, and calves.
How Long Does IT Band Syndrome Take to Heal?
With proper treatment and rehabilitation, IT band syndrome typically resolves within a few weeks.
Conclusion
Iliotibial (IT) band syndrome is a common running injury characterized by outer knee pain.
The IT band is a connective tissue structure running from the hip to the knee, and this syndrome often results from excessive friction or irritation of the band.
Dr. Utku Erdem Özer specializes in treating common running injuries like IT band syndrome. With a patient-centered approach, he helps patients recover and athletes return to their activities.
Thank you for reading our article. For more information, visit our homepage at utkuerdemozer.com.
