Ilio-tibial Band Syndrome

ITB syndrome is a common condition in runners. It is usually brought on by a sudden increase in mileage, excess training in the same direction on the track or an increase in downhill running (Fredrickson, 2005). Some biomechanical studies have noted that ITB friction is less likely to occur in fast paced running.

The cause is thought to be friction and compression of the ilio-tibial band against the bony prominence of the lateral femoral condyle. Jelsing et al (2013) observed anterior-posterior translation of the ITB relative to the lateral femoral condyle during 0-45* of knee flexion.

This increase in friction and compression can be caused by a combination of different factors. Commonly weakness in glut max and glut med contributes to decreased stability of the hip on foot strike, that in turn causes compensatory myofascial restrictions elsewhere. Tensor fascia lata, hip flexors and hamstrings will commonly become stiff and restricted due to this compensatory mechanism (Fredrickson, 2005).

Biomechanical alterations further down the kinetic chain such as medial quads weakness and navicular drop (causing excessive rotation at the foot) can contribute to a lack of rotational control at the hip.

In all likelyhood a combination of the above factors are involved in the onset of ITB syndrome so addressing more than one issue will be required to resolve the symptoms.

Initial management may involve a decrease in mileage, ice and anti-inflammatories. If caught early enough rest for 3-4 days may be sufficient. Rehabilitation exercises are advisable in order to prevent further onset of symptoms once full training has resumed.

If the symptoms come on gradually over a period of time and develop chronicity then rehabilitation  exercises are essential and it may be necessary to rest from running for 2-4 weeks.

Exercises to stretch hip flexors and hamstrings can be found on the lower limb stretches page. Stretching the ITB is a debatable topic as it is unlikely that such a strong and tensile structure can be stretched at all. However, it is thought that the Tensor Fascia Lata muscle  that has an attachment to the ITB is where the stretch occurs.

Hold 15-20 seconds and repeat 3 times on each leg

Hold 15-20 seconds and repeat 3 times on each leg

Gluts strengthening:

Hold 10 secs x 20 reps

Hold 10 secs x 20 reps

wpid-photo-23-may-2012-2035 wpid-photo-23-may-2012-1921 wpid-photo-23-may-2012-2042

Pictures taken from Frederickson (2000) and Boren (2011), who have used EMG studies to show the most effective exercises for Gluteus Medius strengthening.

Mearden et al (2012) looked at running gait in ITB syndrome and found that  symptomatic runners tended to have a narrower stride width and therefore tended to drop into hip adduction on stance phase and increase ITB friction at the knee. They suggested that increasing stride width may help to minimise symptoms.

A podiatry assessment and prescription of orthotics may be useful to alter rearfoor/forefoot biomechanics to lessen the torsional forces through the hip and knee.

This is meant to be an overview of some likely causes and treatment strategies in ITB syndrome and is by no means exhaustive. When symptoms have resolved sufficiently to return to running make sure you increase your training schedule gradually and continue with the rehabilitation programme outlined above.

It is advisable to seek expert assessment for a diagnosis to ensure you are treating the correct source of symptoms!



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