The IT Band Syndrome – causes and treatment options

The Iliotibial band syndrome (ITBS) is a non-traumatic overuse injury that often affects long-distance runners or cyclists. Approximately 12% of overuse injuries in runners and about 15% in cyclists are related to the ITB. (1). Therefore, chances are high that you will treat many patients suffering from this condition, especially if your practice is focused on sports injuries.

Most cases of ITBS can be solved with a conservative treatment approach with an emphasis on rehabilitative exercise programs. Cases of surgical interventions are rare and only suggested if all options of conservative treatment fail.

However, successful treatment requires patience and compliance with the prescribed exercise programs. This article will explain some of the most common causes of the IT Band Syndrome and provide exercise suggestions that patients can do with their providers or as part of a home exercise program.

What is the IT Band Syndrome?

The Iliotibial (IT) band is a thick band of fascia that runs along the lateral or outside of the knee, extending from the outside of the pelvis, over the hip and inserting just below the knee. Its major role is to stabilize the knee and abduct the hip by moving from behind the thighbone (femur) to the front of the thighbone during activities such as walking or running. It is also capable of resisting substantial varus torques at the knee. (2)

ITBS is an inflammatory response caused by a repetitive strain that presents as pain in the outer part of the knee and often aggravates during activities such as running or cycling. The inflammation of the bursa can lead to decreased range of motion, which often results in inefficient running gait. (3)

The symptoms of the ITBS include: tightness of the affected muscles, gradual onset of burning or pain at the lateral part of the knee during activity, radiation of pain to the outside of the thigh, aggravation of pain during repetitive activities (e.g. running or cycling), swelling of area where the IT band moves over the thigh bone.

What are some common causes for the ITBS?

ITBS is often triggered by sudden changes in training intensity or quantity. When the training is not progressed adequately (i.e. more than 5 – 10% per week)*, the muscles, tendons, ligaments, and bones of the knee, hip and pelvis cannot adapt appropriately to the increased stress. (4)

Weakness of the muscles that help the knee to stay in its optimal position including the Gluteus Maximus, Gluteus Medius and the TLF also contribute to the development of the ITBS. In a study by Taunton et al in 2005, 33% of the subjects reported knee varus and 15% knee valgus. (5)

Other risk factors include improper footwear or inadequate warm-up or cool-down.

What are treatment approaches for the ITBS?

Conservative treatment methods including rehabilitative exercise programs and manual therapy seem to solve most cases of the ITBS. (6) In severe cases, cortisone injections can be an option. Surgery should only be considered if all conservative options fail.

Exercise programs to improve mobility and strength

As the major causes of the ITBS include tightness of the IT Band and weakness of the muscles that surround the knee and the pelvis, the rehabilitation program must focus on correcting these dysfunctions.

Mobility Training:

According to a study from the European Journal of Sports Medicine, both static stretching and myofascial release are effective in reducing tightness of the IT band and range of motion in the hip muscles. (7)

However, according to a study from the Journal of Sports Rehabilitation, Self-Myofascial Release (SMR) using a foam roller is even more effective for increasing flexibility when combined with static stretching. This was demonstrated when comparing foam rolling and static stretching of the hamstring muscles. The study findings indicate using the foam roll for SMR in addition to static stretching is superior to either SMR or static stretching alone (8).

Strength Training:

Studies have shown that strength programs focusing on the glutes medius can significantly improve the ITBS in runners. (9)

Here are examples for a stretch, a myofascial release, and a strengthening exercise. You can find these and many more options in your WebExercises library.

ITB Foam Roll

Lie on side, supporting upper body with elbow positioned directly underneath shoulder. Place foam roll under side of thigh and cross opposite leg over so that foot is firmly on floor.

Slowly move foam roll throughout outer thigh, from hip to knee as tolerated, for a duration of 1 to 2 minutes. Maintain consistent pressure with foam roll. If a painful area is found, stop rolling and REST on the area for 10 seconds as tolerated, then continue. Rest and repeat for prescribed repetitions and sets. Alternate sides as directed. Click here to watch the exercise video.

ITB Stretch

Begin standing next to wall or sturdy chair without wheels. Side to be stretched should be closest to the wall/chair. Place hand on the wall for stability and support. Leg closest to wall/chair crosses behind the opposite leg. Slowly lean hips toward the wall until a stretch is felt in the outside hip region. Hold for 20-30 seconds or for the prescribed duration. Repeat for prescribed repetitions and sets.

Click HERE for the Exercise Video.

Banded Clam Shell

Begin lying on the side with knees together and bent to 90 degrees. Place a resistance band around knees. Support head with your hand or with a pillow. Activate core. Lift knee upward while keeping soles of shoes touching. Continue lifting knee to the point just before your pelvis begins to move. Keeping core activated is essential to isolating hip muscles and not moving pelvis. Repeat for prescribed sets and reps. Click here for the exercise video.


You can find an IT protocol and progressions for the different exercises in your WebExercises library.

Keeping the momentum and prevent future injuries:

As for all exercise protocols, it is important to conduct the exercises on a regular basis for a minimum of 6 weeks. If the condition is chronic, the recovery time can take longer. For optimal results, it’s crucial to adjust the exercise program based on the patient’s feedback to make sure he or she keeps on progressing. Read our blog post on Exercise Progressions to learn more.

References:

  • Michael D. Milligan, MD: Bicycling Related-Iliotibial Band Syndrome, 2007
  • Robert L. Baker, BSPT, MBA, Richard B. Souza, PhD, PT, Michael Fredericson, MD: me: Soft Tissue and Biomechanical Factors in Evaluation and Treatment, 2011
  • Fredrickson M, Wolf C. Iliotibial band friction Syndrome in runners: Innovations in treatment, 2005
  • Beaudoin CM, Blum JW. Flexibility and running economy in female collegiate track athletes, 2005
  • Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD: A retrospective case-control analysis of 2002 running injuries, 2005
  • Joshua Dubin, DC, CCSP, CSCS: Evidence Based Treatment for the Iliotibial Band Friction Syndrome
  • A. Muragod, V.R. Patil, P. Nitsure: Immediate Effects of static stretching versus myofascial release in IT band tightness in long distance runners – a randomized clinical trial
  • Mohr, A., et al. (2014) Effect of foam rolling and static stretching on passive hip-flexion range of motion. Journal of Sport Rehabilitation.
  • Robert L. Baker, BSPT, MBA, Richard B. Souza, PhD, PT, Michael Fredericson, MD: me: Soft Tissue and Biomechanical Factors in Evaluation and Treatment, 2011

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