What is Iliotibial Band Syndrome & How to Treat it

Dr. David Johnston

Iliotibial Band Syndrome (ITBS) is most commonly known as ‘runners knee,’ but can result from other factors as well the cause the iliotibial band (ITB) to become tight. Anything from overuse, tight tissues, weak hip muscles, poor running form and even shoe or orthotic issues can cause ITBS. Overall, the lack of strength and flexibility can limit your knees ability to perform with ease.

The iliotibial band is a ligament that stretches from your hip to the outside of your thigh, all the way down to your shin. This ligament helps stabilize the joints, providing smooth transitions within each movement you make. This is especially important during any 30-45 degree bends in the knee, like in cycling or running.

As pain occurs, the iliotibial band, a strong fibrous band of tissue that attaches to the tensor fascia lata (TFL) muscle, begins to tighten. This pain can be felt because as the ITB tightens, it rubs against the femoral condyle right below the knee joint, causing friction that results in inflammation and minor trauma.

Symptoms of ITBS

The most widely felt symptom of Iliotibial Band Syndrome (ITBS) is pain on the outside of the knee. This pain will elevate during any activity that puts strain on the ITB ligament, like running. The pain may start off subtle but gradually get worse as more stress is put on the knee without proper strengthening and stretching. It can also be very common for the pain to go away when you are not active, like sitting for a long time, but then come back once any movement is made by straightening or bending the knee again. Often, the pain will only be felt on one side, a result from the muscle groups not being balanced during activity.

Why does ITBS Happen?  

Iliotibial Band Syndrome happens because the tensor fascia lata muscle (TFL) and ITB become too tight from being overworked or overused. This is a direct result from the lack of strength and flexibility which will end up making the muscle groups work harder, causing painful strains of the knee.

The TFL and ITB play a crucial role in the functioning of the gluteus medius. The gluteus medius is a broad, thick muscle meant to stabilize and provide strength to your hips. So how is the TFL & ITB relevant? These two muscles abduct the thigh, assisting in the flexing and movement of the legs outward while also rotating the hip through the gluteus medius. Now, when the TFL and ITB become too tight, it inhibits the gluteus medius from keeping the pelvis level because it is making it work harder, eventually wearing it out and weakening the gluteus medius. This mis-balance continues to have to make one side work harder for the same results and as this cycle continues, one knee begins to suffer.

Tricks to Manage & Prevent Pain from ITBS

Stretching Exercises

Stretching the muscles on the outside and around the hip are actually particularly important because the TFL and ITB feed it during activity.

Some helpful stretches include:

  • Foam Roller Exercise – allow the foam roller to be rolled down the Iliotibial Band, massaging the area to create blood flow.
  • Glute Stretch – Lay on your back with both legs straight. Pull one knee to your chest for a hug. Hold for 30 seconds and repeat on the other side. Repeat over for 3-5 times.

Strengthening Exercises

The best thing to strengthen when managing and working on health the ITBS is to focus on the tensor fascia lata (TFL) and gluteus medius.

Some helpful strengthening exercises include:

  • Hip Abductions
  • Clam Exercise
  • Heel Drop

Ice On, Ice Off

Try putting ice on for 10 minutes at a time, and then taking the ice off for 10 minutes. You can do this to reduce inflammation and strain.  

How Can an Osteopathic Doctor Help?

An Osteopathic doctor can examine the iliotibial band without doing any invasive treatments. A normal visitation may look like the doctor assessing for the overall strength in the hip, leg and knee. Looking for muscular imbalance, areas of strain and examining your walking or running stride are all possible. In addition, examining your shoes and seeing if any orthotic issues could be causing the ITBS are also probable. Treatment may consist of manipulation techniques, stretches, soft tissue release and any discussions of plans to assist in your way to recovery.

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