If you’ve ever come across the word ITB, it’s usually because someone has told you to foam roll it and it’s seriously painful. For those that haven’t had this pleasure, the ITB (Iliotibial band) is a common source of pain in the lateral aspect of the knee. It is commonly referred to as Iliotibial Band Syndrome (ITB Syndrome). Generally, this condition presents in people involved in activities such as running or cycling. These activities involve a lot of knee flexion and extension. Historically, it was considered that ITB Syndrome was caused by friction of the ITB at the lateral knee. However, more recently, it has been suggested that the ITB actually compresses the surrounding structures instead.
Contrary to most thoughts, the ITB is not a muscle, therefore it does not contract and relax or provoke movement like a normal muscle group would. The ITB is a very thick and fibrous band extending from the hip, along the outside of the thigh, into the knee. Despite its lack of assistance to function the knee, it does, however, provide stability for the hip and knee. Research suggests that it should be treated like a spring, as it stores and releases energy.
Most commonly, symptoms tend to include pain at the lateral aspect of the knee with running or walking up hills and up/down stairs. There is no bruising involved but in some cases minor swelling may be present. ITB Syndrome is usually caused by weakness of your proximal stabilisers (ie. your glutes) or a biomechanical dysfunction with running. Increased volume of training generally speeds these processes up, resulting in the onset of pain.
Treatment of ITB Syndrome generally consists of treating the factors that have allowed it to present in the first place. The first aim of treatment is to settle acute pain levels by reducing the provocative activity. This means to stop any running, cycling or training that caused your pain to present. A relative strengthening programme should be trialled, focusing on key areas of weakness. This mainly centres around the hips. Depending on pain levels, this can be started with low intensity exercises in non-weightbearing positions. Then you can progress into more functional and weighted exercises. The last phase of rehabilitation should aim to increase loading of training and mimic demands of the chosen activity.
Until recently, stretching the ITB has been considered a common practice in the recovery and rehabilitation to reduce the lateral friction. However, research now suggests that stretching of this structure is not possible, nor will it assist in your treatment.
If you’re currently struggling with lateral knee pain then book in to see our team of experienced physiotherapists at Cairnhill to get back to pain free exercise!