Iliotibial Band Syndrome

Iliotibial Band Syndrome Description
Iliotibial Band Syndrome is a common cause of pain around the knee and thigh in runner's.  Iliotibial band syndrome is often referred to as Runner's knee.  Other common terms / synonyms for iliotibial band syndrome are: iliotibial band friction syndrome,  ITBS, and ITBFS.  The iliotibial band is a strong fascial band the connects muscles in the hip and thigh to tibial just below the knee.  This band of tissue moves across a bony prominence in the knee called the lateral epicondyle.  The friction from the band moving back and forth acrosss the bony prominence causes iliotibial band syndrome.

Iliotibial Band Syndrome Anatomy
Iliotibial Band Syndrome is associated with anatomic factors producing increases lateral knee forces: genu varus, tibia vara, heel varus, forefoot suppination and compensatory foot pronation

Iliotibial Band Syndrome Symptoms
Iliotibial band syndrome causes pain, tenderness,  and occasionally swelling on the outside of the knee (lateral side).  The pain may radiate up into the thigh, or down into the leg.  In early phases of Runner’s knee the pain may only occur at the beginning of exercise and may go away once the knee is warmed up.    Without treatment iliotibial band syndrome may worsen and become continuous.  In severe cases of iliotibial band syndrome the pain may persist even after exercise or at rest.  The pain is often worse with hills or stairs or when running on banked or slopped surfaces.  The symptoms are ofter worse with downhill running.

Iliotibial Band Syndrome Treatment 
Iliotibial Band Syndrome s diagnosed based on a detailed history, physical exam and xrays performed by an orthopaedic surgeon, or sports medicine specialist.  Xrays of the knee of often taken and are usually normal.

Treatment of iliotibial band syndrome begins with changing the  running activities, such as running down hill, and running in the same direction on the track, which are causing the knee pain.   It is important to ensure running shoes do not over pronate or suppinate the foot.  Changing stride length can also be beneficial. Cyclics can change seat height.  Icing the knee before and after exercise is important and can reduce the symptoms of IT band syndrome.  NSAIDs such as motrin and Alieve are helpful.  It is very importand to stretch properly before exercise.  IT band and hip external rotator stretching and strengthening hip abductors helps prevent IT band syndrome.  Iliotibial Band Compression Wrap can be benefiical.  Occasional formal physical therapy, cortisone injections or iontophoresis is used for IT band syndrome.

For people with malalignment issues there are orthotics which may be beneficial such as rigid orthotics for excessive pronation or lateral heel wedges.

It is very uncommon to require surgery for iliotibial band syndrome.  Surgery is only consisdered  after failure of prolonged non-operative treatment. Surgery may involve resection of the triangular piece of the iliotibial band that contacts the lateral femoral epicondyle when the knee is flexed to 30 degrees.

Athletes returning to sports after Iliotibial Band Syndrome should begin with a graduated exercise program. First they should be pain free with daily activities with full range of motion and at least 85% strength in the injured leg compared to the uninjured leg. Exercise begins with light jogging in a straight line, followed by gradually increased speed and distance. 

Iliotibial Band Syndrome Prevention
Prevention of Iliotibial Band Syndrome begins first with proper warm up and stretching prior to exercise or sporting activity.  IT band stretches and hip abductor and external rotator stretches are important.  Appropriately warm up and stretch before practice or
competition.  Avoiding running on hills, banked surfaces and in the same direction on circular tracks

Everyone foot is different and it is important to know if your foot is neutral, over pronates or over suppinations and to wear the appropriate shoes for your feet

Iliotibial Band Syndrome Risk Factors
Iliotibial Band Syndrome is associated the following sports: Basketball; Cycling; Dance; Running;Weight Lifting.  Iliotibial band syndrome is most common in long distance runners.  Ilitobial band syndrome is associated with malalignment of the lower extremity.  Malalignment problems that are linked to iliotibial band syndrome include: genu varum, tibial vara, heel varus, forefoot supination

Iliotibial Band Syndrome Rehab and Exercise Program
Iliotibial Band Syndrome

Iliotibial Band Syndrome Outcomes
Iliotibial Band Syndrome generally resolves within 6 weeks to 3 months with appropriate treatment.  It is not uncommon to have recurrence if the underlying causes such as malalignment, improper shoes or poor training technique are not corrected. 

Similar injuries that can be confused with Iliotibial Band Syndrome include:  

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