Iliotibial band syndrome is often called IT band syndrome. It’s a health problem that causes pain on the outside of the knee. It most commonly happens in athletes, especially distance runners, or those new to exercise.

To be able to understand more about IT Band Syndrome, it is best to understand basic anatomy. The bones of your knee joint are your thighbone (femur), your shinbone (tibia) and your kneecap (patella). The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh from the iliac crest and inserts at the knee. It is composed of dense fibrous connective tissue.

When you bend and extend your leg, this band moves over the outer lower edge of your thighbone. With repeated bending and extending of the knee, this movement of the iliotibial band may irritate nearby tissue, causing pain.

What causes iliotibial band syndrome?

Pain from IT Band Syndrome can be related to friction as it moves over the lower outer edge of the thighbone. Inflammation may arise in places like bone, tendons and small, fluid-filled sacs in the area. Another cause of pain may be due to compression of tissues underneath the band. Weakness of hip abductors can be a cause as this may lead to hip adduction and internal rotation. This constant friction due to repetitive bending and extending of the knee is thought to be responsible for iliotibial band syndrome.    

If you’re a runner, you might be more likely to develop iliotibial band syndrome if you:

Run on uneven or downhill terrain

Run in worn-out shoes

Run many kilometres per day

Have legs that slope a little inward from your knee to your ankle (bowlegged)

Run in cold weather

If pain is on the acute (new) phase, activity modification is very important. Further aggravation of the symptoms is the number one priority to address. Active rest or working out different parts of the body is the best way forward to continue with workout regimes. Decreasing activities that make the pain worse is important to be considered. Other modalities that may provide pain relief include ice (cryotherapy) or heat, taping and stretching.

Treatment

The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment. First is to identify the cause of pain. It may be due to muscle weakness or imbalance. Identifying these important sites will be able to help you with the next step.

Myofacial treatment can be effective in reducing the pain experience in acute phase, when pain and inflammation in the insertion is felt. The trigger points in viceps femoris, vastus lateralis, gluteus maximus, and tensor fascia latae muscles will be addressed by a myofascial treatment. The use of foam roller on the tight muscles could also be beneficial. This can be done at home (self-myofascial release) by creating deep transversal friction and stretch the muscle after.

To do this, simply lie on the side with the foam roller positioned perpendicular to the bottom leg, just below the hipbone. The upper leg should be positioned in front for balance. Using the hands for support, roll from the top of the outer thigh down to just above the knee, straightening the front leg during the movement. Strengthening of abductor muscles to stabilise the hip can be helpful.

1-Hip bridge with resistance band: An effective yet simple exercise to begin with is the hip bridge utilising a resistance band. By doing so, it increases gluteus maximus activity and reduce anterior pelvic tilt during exercise

2-Side lying hip abduction: The best exercise in isolation the gluteus medius muscle.

3- Lateral band walk: After doing exercises number one and two, you can start working on functional exercise by walking laterally performed on a semi squat position.

4-Side plank: start by performing 3-5 repetitions for 10 seconds each, gradually adding more repetitions.