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Iliotibial Band (ITB) Syndrome

The ITB is a very common and debilitating injury for the long distance runner. Generally there is no history of trauma but a gradual onset of lateral knee pain. The pain usually commences approximately 2-3km into the run and worsens as the run continues. Pain is worst at heel strike when the knee is flexed at approximately 30 degrees.

Often the injury occurs due to a sudden change in training – increased speed, distance or intensity. Other causes of pain which have been reported in the literature include increased hip adduction angles (i.e. feet cross the midline during running) and internal rotation (rolling in) of the knee.

The pain was initially thought to be caused by a frictioning of the ITB over the lateral femoral condyle (the thigh bone just above the knee), but recent research has shown the pain to be caused by compression of the fatty tissue between the lateral femoral condyle and the ITB.

Traditional treatment for the ITB has consisted of painful massage down the ITB. However the ITB is a thick band of connective tissue which has no capacity to stretch or elongate making this a very pain but futile exercise. The TFL (tensor fasciae latae) muscle blends to form the ITB and has the ability to stretch and lengthen and therefore more attention should be spent on releasing through this area to help relieve pressure from the ITB. A large proportion of the glute max inserts onto the ITB so attention should also be made to releasing this area to reduce pressure around the knee.

There is a lack of definitive literature on the best way to treat this injury. Rest definitely has its role but working with a physiotherapist to help correct any excessive hip adduction or knee internal rotation angles is crucial as these have been demonstrated to be linked to the injury. Treatment may take the form of manual therapy or specifically targeted exercises for strengthening the gluteals and other stabiliser muscles, or a combination of both to correct any dysfunctional patterns increasing pressure on the knee. Cortisone injections have been shown to be effective in providing pain relief for up to 14 days post injection but there is little evidence to suggest it helps beyond this period.

Like almost all non-traumatic injuries it is vital to clarify what caused the pain to come on in the first place. Failing to determine the underlying cause often means that the pain will persist and not fully settle, or may settle then flare back up again once you return to a higher volume of training. Our detailed Running Gait Assessment is specifically designed to diagnose underlying problems that can cause knee pain in runners, and allows the implementation of effective programs to improve your strength, stability and running technique to alleviate pressure on your knee. Completing our andRunRight coaching program or joining our Runfit can get you on and the most effective program to build on your improved technique.