Introduction:

Iliotibial band syndrome is an injury that has been seen over the past few years with increasing frequency. It appears to be related to weak hip abductor muscles. Strengthening the hip abductors and stretching the ITB and structures that attach in to it are usually the keys to recovering from this problem.

Symptoms and Causes:

Symptoms of the iliotibial band syndrome include pain or aching on the outer side of the knee. This usually happens in the middle or at the end of a run. A concomitant problem may occur at the hip called greater trochanteric bursitis. During flexion and extension of the knee the iliotibial band rubs over the femoral condyle which leads to irritation. Weak hip abductors, especially the gluteus medius is often found. Some other factors that may contribute to this syndrome include genu varum (bow legs), pronation of the foot (subtalar joint pronation), leg length discrepancy, and running on a crowned surface. We need to emphasize that over the past few years an association with weak gluteus medeus muscles has been found in many runners with ITB syndrome.

“...an association with weak gluteus medius muscles has been found in many runners with ITB syndrome. ”

The function of the muscles inserting into the ITB (Tensor Fascia Lata) is to abduct the leg. If the hip abductors are weak, then the ITB is being overworked. The ITB does not have an insertion that offers a favorable mechanical advantage. In fact, it is at a considerable disadvantage for the purpose of hip and leg abduction activity. Therefore when the hip abductors are weak, the tensor fascia lata must contract harder and over a longer period of time thus straining the ITB. Make sure that part of your cure is to strengthen your hip and leg abductors.

Circular track running may also contribute to ITB, since it stresses the body in a manner similar to that of crowned surfaces and leg length differences. Circular track running was found in research performed on track athletes in the year 2000 to cause asymmetrical muscle strength development. The study did not measure ITB and related muscle strength but found lower down on the leg that the inner leg had stronger inverter strength and the outer leg had stronger everter strength. While it was not studied the outer ITB would likely be placed under much greater stresses than the inner leg. The angles of force acting on it would be

“You will probably find it difficult to balance on the affected leg. ”

greater, just by virtue of the leg and pelvis position requred to run around an oval track. All of these factors can be aggravated by a tight iliotibial band. Changes in

training may also contribute to the development of ITB syndrome. It is always important to examine your training regimen and see what alterations have recently occurred. A rapid increase in running distances and times spent running often precedes the development of this injury.

ITB Friction Syndrome

Anatomy:

The iliotibial band is a thickening of the lateral (outer) soft tissue that envelopes

the leg, which is called the fascia. In this area it is called the fascia lata. The thickened band is called the ilio-tibial band. The muscles that insert into the proximal (upper) portion of this band are the tensor fascia lata and a portion of the gluteus maximus and gluteus medius muscles. During its latter course it splits medially into the iliopatellar band and laterally into the iliotibial tract. At its insertion into the tibia at Gerdy's tubercle it blends with the Biceps femoris and the Vastus lateralis.

Hip Muscles

Self-Treatment:

Self treatment for this problem should include:

Side Stretch

The side stretching is performed while standing as follows: Place the injured leg behind the good one. If the left side is the sore side, cross your left leg behind your right one. Then lean away from the injured side towards your right side. There should be a table or chair that you can hold onto for balance on that side. This stretch is the best of several that exist for this area. Be careful not to overstretch. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times.

 

Hip Abductor Strengthening

The hip abductor's strength may be tested by trying to balance on one leg. You will probably find it difficult to balance on the affected leg. You may strengthen your hip abductor muscles by standing on one leg and lifting or tilting the other hip upward. Keep the knee straight on the leg you are standing on.

If your self-treatment has not been completely successful than a trip to a sports medicine specialist may include the additional treatment of either a steroid injection below the IT band and possible orthotics. Treatment is usually succesful for this problem.

References:

Fredericson M, Guillet M, DeBenedictis L. Quick solutions for the iliotibial syndrome. Physician Sportsmed 2000; 10(3)169-175.

Schwellnus MP. Lower limb biomechanics in runners with the iliotibial band friction syndrome. Med Sci Sports Ex: 1993;25(5):S68.

Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and the iliotibial tract. Am J Sports Med 1986; 14(1):39-45.