Iliotibial Band Syndrome, also known as "IT Band Syndrome", refers to pain and inflammation experienced over the lateral aspect of the knee during flexion and extension. The iliotibial band (ITB) is a thick band of tissue which originates from the pelvis and inserts into the lower leg (tibia) and indirectly into the knee cap (patella). During flexion and extension of the knee, the ITB slides over a bony protrusion of the upper leg bone (lateral femoral epicondyle). Irritation of the ITB occurs when factors exist which cause excessive friction of the ITB over the femoral epicondyle. Tightness of the ITB increases the friction of the band as it passes over the epicondyle. Excessive friction eventually will cause pain and start an inflammatory reaction. The inflammation may result in scar tissue formation, adhering the ITB to surrounding structures causing further dysfunction and exacerbation of the problem. ITB syndrome is a common injury among runners and cyclists due to the repetitive knee flexion and extension performed during the sport. IT Band Syndrome is also commonly referred to as "Runner's Knee".

ANATOMY

The IT Band connects the pelvis (ilium), upper leg (femur) and lower leg (tibia and fibula). It is soft tissue called fascia that originates from the waist and the lateral tubercle of the ilium, and extends down the side of the leg, attaching to the outside of the tibia and fibula. Closer to the knee joint, the ITB blends with fascia that inserts into the patella and influences tracking of the knee cap. The ITB also blends with the gluteus maximus and tensor fascia lata muscles in the pelvis. An imbalance in strength of these two muscle groups can cause the resting position of the ITB to shift forward or backward, predisposing the athlete to injury.

SYMPTOMS

• Pain or aching along the length of the IT Band on the outside of the hip, the greater trochanter, thigh, upper leg and/or more commonly, the knee
• Pain may occur during or shortly after a run or activity
• Crepitus over the lateral knee
• Tenderness in surrounding muscles as a result of abnormal compensation of the body to protect the injured structure.

FACTORS ATTRIBUTING TO ILIOTIBIAL BAND SYNDROME

• Running
• Cycling
• Poor training
• Lack of stretching
• Muscle spasms in surrounding areas
• Weak surrounding muscles
• Altered biomechanics of any joint of the lower extremity
• Leg length discrepancies
• Bow legs
• Foot pronation
• Occupation-prolonged sitting, heavy lifting and carrying

ASSESSMENT

Assessing the area to determine the factors contributing to the syndrome will determine the focus of the treatment. Specific tests may indicate decreased tissue length of the IT Band, weakness of surrounding musculature, and altered joint mechanics. Tenderness at specific locations will also aid in determining the focus of treatment. Treatment focus may be the origin of the ITB at the hip, its insertion into the knee, surrounding musculature of the ITB, or a combination of the three.

MASSAGE THERAPY GOALS

• Increase the length of the IT Band along the thigh, regaining range of motion lost
• Increase circulation, flushing out built up toxins and any metabolic wastes that occur within the tissues before and after treatment
• Decrease hypertonicity spasm or tightness in muscles surrounding the area
• Promote tissue health
• Return to daily activities without pain

PHYSIOTHERAPY GOALS

• Restore normal joint biomechanics (mobility) of the lower extremity
• Develop an exercise program to address muscle imbalances of the lower extremity and pelvis
• Decrease pain
• Decrease inflammation
• Promote gradual safe return to sport

LONG TERM TREATMENT GOALS

Prevent future reoccurrence of symptoms by providing patient education with regards to early identification of symptoms, the importance of proper warm up / stretching, and safe training progression.

References:

1. Rattray, Fiona S. "Iliotibial Band Syndrome." Massage Therapy, An Approach to Treatments. 1995; 171-76.
2. "2 Iliotibial Band Syndrome Illustrations" Sports Medicine Advisor, 2004.