Iliotibial (IT) Band Syndrome

What is it?

IT band syndrome is where your IT band (a tendon on the outside of your leg) becomes swollen or irritated from rubbing against your hip and/or knee bones. This can happen when the tendon becomes too tense. You can suffer from this on one leg or on both. It is known as bilateral iliotibial band syndrome if it’s the latter.

How common is it?

IT band syndrome is common amongst sports like basketball, cycling, hockey, football, skiing and of course running. Frequent runners, long-distance runner in particular, can be prone to the condition. Approximately 10-15% of all running injuries are IT band related.

Primarily caused by:

• Excessive foot pronation - Basically, if your foot naturally rotates outwards, the whole outside of your leg, including the IT band, are stretched.
• Hip abductor weakness - Having weak gluteal muscles and/or weak tensor fascia latae can result in your IT band becoming increasingly tense to compensate for this weakness.
• Internal tibial torsion – Your shinbone aka your tibia, may twist inward and would result in your it band being pulled closer to your bones.
• Bow legged (genu varum) knees – Again this results in extra tension along your IT band as your knees are spread further apart.
• There is in some cases, people who just have a slightly tighter IT band which can increase the risk of the dysfunction.

Other causes:

Repeated knee flexion and extension increases the risk of irritation if the above risk factors are evident. Poor warm up and/or cooldown for exercise and a lack of mobility work and stretching are said to be common variables in increasing the likelihood of developing the condition. Similarly, pushing too hard when exercising, lack of rest and recovery periods during and post exercise, running on uneven surfaces and worn runners are also risk factors.

What symptoms are associated with the condition?

• Hip pain caused by increased friction between your It band and the greater trochanter of your hip (this is where the hip widens near the top of the femur). This can cause pain due to increased inflammation of the tendon.
• Clicking sounds coming from the outside of the knee are often heard.
• Knee pain on the lateral epicondyle (outside of the knee) where the IT band may be rubbing against.
• Inflammation on the outside of the knee. Swelling, discoloured skin and/or the skin feeling warm to touch.

Management and Treatment?

• Potentially seeing a healthcare professional such as a physio for an assessment and to obtain advice regarding rest and activity levels.
• Use of anti-inflammatory meds such as ibuprofen in the early stages if required. Again discussing this with your healthcare provider regarding dosages.
• Manual therapy – Foam rolling and massage on tight muscles can be of significant benefit.
• Physical therapy – It is important to strengthen the aforementioned muscles and reduce any weakness evident in these muscle groups. Hip abduction strengthening exercises and hip stability work are extremely important. Glute bridges, side-lying hip abduction, lateral band walks and side planks are all really useful exercises for this specific condition.
• In more extreme cases, steroid injections or surgery may be utilised.

On average, it takes between 6-8 weeks for physical therapy treatments to show their benefit and a reduction in symptom severity.

Written by Gavin Smith – Health & Performance Scientist. Final Year UCD Physiotherapist.