Iliotibial Band Syndrome (ITBS).

Iliotibial Band Syndrome (ITBS).

What is the Iliotibal Band?
The Iliotibial Band (ITB) is a band of collegen fibres that extend from the Tensor Fascia Lata(TFL) and Gluteus Maximus down over the knee joint to the tibia. This provides a brace that protects the knee from moving sideways.

What is the Syndrome?
ITBS is simply chronic inflammation of the ITB that causes severe pain when walking and running. It is caused by repetitive friction of the ITB over the femoral epicondyle which irritates the fibres eventually leading to inflammation and pain.

Aetiology.
Due to the overuse nature of the syndrome runners are most at risk of ITBS followed by cyclists. Factors that are associated with ITBS are excessive running the same way around an oval, extra mileage than normal and down hill running.

Signs and Symptoms.
The first sign of ITBS is knee pain, especially behind and the side of the knee, followed by inflammation. Flexibility and strength is also limited in the iliopsoas, rectus femoris and hip abductors.

Treatment.
There are four stages in treatment/ rehabilitation of ITBS.
1. Acute Phase
2. Subacute Phase
3. Recovery and strength phase
4. Return to run phase


The Acute Phase.
The aim of this phase is to reduce the amount of inflammation using ice, non steroidal anti-inflammatory drugs and a reduction in exercise.

The Subacute phase.
Once the inflammation has reduced, the next goal is to release the myofascial restrictions or return normal flexibility. This is done by doing ITB stretches and using the foam roller. (See picture)

Strength phase.
Once flexibility is retained it is time to strengthen and retrain the hip abductors by doing resistance training.

Return to running phase.
Once strength has returned, the athlete can return to training but with a much smaller work load. Runners are also advised to avoid running down hill for the first 4 weeks of training.

Most athletes respond to this treatment, however if ITBS persists there is a surgical option that decreases the amount of impingement of the ITB on the femoral epicondyle.