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Iliotibial (IT) Band Syndrome


Iliotibial (IT) Band Syndrome

Iliotibial band syndrome, also known as IT band friction syndrome, is a condition that causes pain on the outer part of the knee. It is most common among athletes, particularly runners and cyclists.

The IT band is a thick, strong, and long connective tissue that starts at the pelvis and stretches down the outer part of the thigh bone, passing over the bony protrusion on the outer part of the hip bone (the greater trochanter), continuing down the outer part of the thigh, and then attaching to a bony bump on the shinbone (tibia) called the Gerdy's tubercle. It is one of the least flexible structures in our body.

The area where it most commonly causes pain is the outer part of the knee joint, where it passes over the bony structure on the outer side of the lateral femoral condyle. The second most common area for pain is the outer part of the hip joint (the outer side of the greater trochanter).

When you bend and extend your leg, this band moves over the outer lower edge of your thigh bone. In particular, the repetitive bending and extending of the knee in runners and cyclists cause the iliotibial band's movement to irritate nearby tissues, resulting in pain.

Iliotibial Band Syndrome can occur in anyone. While it is more common in athletes, it can also be seen in a significant number of patients over the age of 60 with bowed legs and knee joint cartilage disorder (Gonarthrosis).

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.

Who is at Risk for Iliotibial (IT) Band Syndrome?

Iliotibial IT band syndrome is most commonly seen in running athletes. However, it can also occur in those who participate in other sports such as cycling, skiing, rowing, or football.

If you are a runner, you may have a higher chance of developing Iliotibial (IT) band syndrome in the following situations:

  • Running on uneven or downhill terrain

  • Running in worn-out shoes

  • Increasing weekly total running distance by more than 15% at once

  • Having bowed leg deformity

  • Running in cold weather

What are the Symptoms of Iliotibial (IT) Band Syndrome?

IT band syndrome causes pain on the outer part of the knee. It can affect one or both of your knees. The pain can sometimes start at the knee and extend all the way up the thigh to the hip. A burning sensation may also be present. Pain may only occur during exercise, especially running, and most patients do not experience pain at rest. The pain is most intense right after your foot touches the ground while running. It can start after 3-4 kilometers into a training session or sometimes towards the end of the session.

As IT band pain becomes chronic, your pain may start earlier and persist even in daily life after stopping running. Activities that may worsen your pain include walking uphill and downhill, and climbing stairs.

How is Iliotibial (IT) Band Syndrome Diagnosed?

After a comprehensive physical examination, it is not difficult to diagnose IT band syndrome. During the examination, tests for the range of motion, strength, and painful areas of your knee will be performed. It is often confused with an external meniscus tear. This is because the location of the pain in the IT band syndrome is almost identical to the pain caused by an external meniscus tear. If the diagnosis is not clear, imaging methods such as X-rays or MRI may be used to rule out other possible causes.

How is Iliotibial (IT) Band Syndrome Treated?

Initially, treatment begins with ice therapy and pain relievers recommended by your doctor.

There are two main focuses in treatment.

The first is to strengthen the gluteus maximus, gluteus medius, and minimus muscles, which stabilize the hip joint. The second is to stretch the iliotibial (IT) band.

However, it should not be forgotten that stretching the iliotibial (IT) band is one of the most challenging tissues in our body. There is no standard recipe for stretching, as it varies from person to person. In my personal experience, I have achieved excellent results with this stretching exercise both for myself and my patients. If you cannot achieve results by performing this movement yourself, working with an experienced sports physiotherapist will be more beneficial.

In cycling athletes, there may often be a problem with the bicycle's adjustment according to the athlete (bike-fit). This problem often results from an improper saddle height and incorrect locked pedal-shoe adjustment.

Can Iliotibial (IT) Band Syndrome Be Operated On?

These treatments help almost all athletes with iliotibial band syndrome. If your pain cannot be controlled despite applying the above treatments under doctor supervision with a health professional (physiotherapist), surgical treatment options are reviewed. There are many different techniques, such as cutting the iliotibial band in a Z shape to extend it or removing the part that moves over the lateral femoral condyle. Nowadays, most patients with iliotibial band syndrome requiring surgical treatment have an excessive thickening-fibrosis (connective tissue increase) or bursitis (inflammation of the bursa) in the iliotibial band where it passes over the outer part of the lateral femoral condyle. If surgery is planned, these tissues are removed.

Can Iliotibial (IT) Band Syndrome Be Prevented, What Can I Do to Prevent It?

In most cases, IT band syndrome can be prevented.

  • Train on flat surfaces until your body adapts to the sport.

  • Regularly change your running shoes (average 600-800 KM).

  • If you're running on a circular course, make sure you run in both directions (half of the total laps clockwise and half counterclockwise).

  • Perform strength exercises outside of running training. These exercises should include core, hip, quadriceps, hamstring, calf, and foot areas.

  • Do not compress your stretching exercises into a tight timeframe; allocate at least 2 days a week for 30-45 minutes.

  • If you are new to running, start slowly and gradually increase your mileage.

By taking these precautions, you can reduce the risk of developing iliotibial (IT) band syndrome and enjoy your sports activities with fewer interruptions due to pain and inflammation.


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