Michael Syska, MPT
Iliotibial band syndrome (ITBS) is one of the most common causes of knee pain. Most individuals who participate in endurance sports, such as running and biking, have experienced ITBS at some point.
What is ITBS?
Iliotibial band syndrome is pain that occurs at the lateral (outside) part of the knee, caused by excessive irritation of the iliotibial band (ITB) where it crosses a prominent area of the thigh bone called the lateral femoral condyle.
Inflammation and irritation arise from friction between the ITB, a soft tissue structure running along the side of the thigh from the pelvis to the knee, and underlying structures, namely the lateral femoral condyle. Typically, ITBS pain occurs with overuse during activities such as running and cycling, as an individual moves through repetitive straightening (extension) and bending (flexion) of the knee. The compression and shearing forces produced by these repetitive activities can be further increased by poor alignment and/or muscular control of the lower body, resulting in even more irritation and pain.
Structures commonly involved in ITBS:
• Iliotibial band (ITB)
• Bursa (a fluid-filled sack that sits between bones and soft tissues to limit friction)
• Hip muscles (Tensor Fascia Lata, Gluteus Maximus, Gluteus Medius)
ITBS can occur in:
• Athletes performing endurance sports like biking and running, or repetitive activities, such as squatting.
• Individuals who spend long periods of time in prolonged positions, such as sitting or standing for a long workday, climbing, squatting, or kneeling.
• Individuals who quickly start a new exercise regimen without proper preparation or warm-up.
Signs and Symptoms of Iliotibial band syndrome:
• Stabbing or stinging pain along the outside of the knee
• A feeling of the ITB “snapping” over the knee as it bends and straightens
• Swelling near the outside of your knee
• Occasionally, tightness and pain at the outside of the hip
• Continuous pain following activity – particularly with walking, ascending or descending stairs, or moving from a sitting to standing position
Pain is usually most intense at the point where the iliotibial band rubs the most over the femur, which is when the knee is in a slightly bent position, either right before or right after the foot strikes the ground.
How Is ITBS Diagnosed?
• Examination of medical history and activity regimen.
• Physical examination, including range of motion, strength, and flexibility measurements at the hip, knee, and ankle.
• Assessment of walking/running mechanics, foot structure, and balance. Your therapist might also ask you about your chosen sport, shoes, training routes, and exercise routine.
• Typically, medical imaging tests, such as x-ray and MRI, are not needed to diagnosis ITBS.
Stay tuned for Part 2: Treatment and Prevention
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