Iliotibial band syndrome (ITBS) occurs as the result of irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle – the end of the femur (thigh bone). The iliotibial band crosses both bone and muscle at this point; between these structures is a bursa (sack filled with fluid) which should allow a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, which results in pain associated with movement.
The function of the iliotibial band is both to provide stability to the knee and to assist in flexion of the knee joint. When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.
Symptoms of ITBS include:
- Pain over the outside of the knee joint
- Localized swelling at the location of discomfort
- A snapping or popping sensation when the knee is bent
Endurance athletes are prone to developing iliotibial band syndrome. Athletes who suddenly increase their level of activity often develop iliotibial band syndrome.
Controlling the inflammation of iliotibial band is the initial priority in the treatment plan.
- Rest is the first step to allowing inflammation to subside. If cross-training does not cause discomfort, then it is reasonable at low levels.
- Ice. Icing the area will relieve swelling, therefore reducing the pain.
- Anti-inflammatory medications are frequently recommended to relieve inflammation of the iliotibial band.
Once the acute symptoms have been settled, patients should make efforts to increase flexibility and strength of the hip and knee. Runners, cyclists and other endurance athletes should find cross-training techniques that allow maintenance of their endurance without continuation of their discomfort. This should be done with the guidance of a physiotherapist.
The biomechanics of the foot needs to be neutral. Excessive foot pronation and internal rotation needs to be controlled using a functional orthotic device.
Cortisone injection into the area of inflammation may be attempted, usually after these other treatments have proved unsuccessful. If all else fails to relieve the discomfort of ITBS, surgery is an option.