Iliotibial Band Syndrome (ITBS), aka Iliotibial Band Friction Syndrome (ITBFS), is a very common thigh injury known to runners, cyclists and hikers. It usually presents clinically as a
stinging pain at the side or length of the affected knee and hip.
Its name is from the ilotibial band (see the picture) rubbing against the bony bump at the side of your knee or hip. How that happens is that the iliotibial band is a very thick band of fibrous tissue that starts from our largest hip muscles and goes along the outer side of or thighs and inserts into the tibial bone below the knee.
So before it inserts into the knee, it "runs" over a bony protusion at the thigh bone (this is the lateral femoral epicondyle"), and when this happens repeatedly over time usually due to repeated bending and straigthening of the knee, this leads to a localized inflammation at the ITB.
Unfortunately, as the iliotibial band is also part muscle, it can be very tight too especially if you
very regularly...and the more regular or intense your trainings, the more it'd cause your ITB to rub over the bony protusion, and it'd cause more painful inflammation in turn.
Please note that iliotibial band pain syndrome is not just for the runners, hikers, swimmers or cyclists - unfortunately it may/can affect anyone who increases their activity or sports too fast too intense...and so we see such cases quite often in our physio clinics.
Increased risk factors of iliotibial band pain syndrome includes
The most vulnerable range of knee flexion that starts and
perpetuates this condition is when the knees are flexed at 30 – 40 degrees –
this is where the ITB crosses most frictionally over the lateral femoral condyle (that's why cyclists and runners are most often at risk for this condition unfortunately).
There are a total of THREE (3) things that causes and/or aggravates tightness to the ITB, and they are:
Improper Training/Training Methods
When runners or hikers train improperly, such as
– all these increases strain over the ITB. Also, avid cyclists who prefers to point their toes inwards instead of aligning their toes in a neutral forwards-facing pulls the ITB to more length, causing it to work harder along the extended length, aggravating the tightening the ITB.
Improper Walking Patterns
always causes the ITB to tighten on one side, because one side is worked harder than the other, causing direct imbalance, leading to compensation and overworking.
For cases such as this, physiotherapy biomechanical assessment on your walking pattern will identify and pinpoint the problem and we can improve on patients muscles and joints.
Where it is appropriate, our senior physiotherapists may prescribe supporting foot orthotics such as full or semi-customized insoles to correct or minimise these problems.
Weakness Of The Outer Hip Muscles
Weakness of our outer hip muscles causes our iliotibial band to overwork to compensate for it. This increases ITB tightness and gradually becoming an Iliotibial Band Friction Syndrome.
A combination of regular deep tissue
massage and myofascial release to loosen ITBs, stretching and strengthening the weak outer hip muscles
will help to diffuse the load across to ensure that our iliotibial bands don’t overwork or compensate.
Athletes who has high training hours, volume and intensity always have painful iliotibial bands simply because of their high intensity training.
In such situations, regular deep tissue release and massage with our senior sports massage and deep tissue release therapist will help to release your tight iliotibial band (see who your therapist will be), and keep it at optimal length for best sports and training performance.
Do stretch your ITB after every session of exercise and training or games. In fact, especially if you are a seated worker too - untreated tight ITB can cause low back pain as well.