ITB (Iliotibial Band syndrome)

Overview

The iliotibial band is a band of fibrous tissue that runs down the outside of the leg. It arises from the hip and runs down to insert on the outside of the tibia just below the knee joint. This band adds to the stability of the outside of the knee.
ITB syndrome occurs when this band is irritated as it runs over the lateral epicondyle (outside of the end of the femur).  At the lateral epicondyle, the ITB runs over bone and muscle and a bursa (cushion) ensures easy gliding over this area. However, due to numerous causes listed below, this bursa can become inflamed leading to pain with movement. This is essentially a friction syndrome and due to overuse (training too much or increasing intensity too soon). It is extremely common in runners.
Predisposing factors:

• Over training
• Short or tight ITB
• Running on cambered surfaces
• Wrong running shoes (worn or anti-pronation shoes) causes the leg/foot to be pushed inwards
• Downhill running

Diagnosis

The main symptom of ITB syndrome is pain on the outside of the knee. It is normally a sharp pain that comes on with exercise and usually gets better with rest or stopping the activity, but begins again when one starts the activity again (even after a prolonged period of rest).
One normally does not get any swelling but there may be some over the inflamed area on the outside of the knee.
Physical examination usually only yields pain to palpation on the outside of knee. Importantly, there is no increased fluid (effusion) in the knee. The rest of the examination is normal.
There are many other causes of pain on the outside of the knee, but the most important ones to exclude are a meniscus tear on the outside of the knee or a lateral collateral ligament injury. Examination may be sufficient to excude these conditions, but sometimes an MRI is needed.

Treatment Options

Treatment options include:

• Ice

Applying an ice pack for 15-20 min 4 times a day can help to relieve pain and settle the inflammation

• Medication

Taking anti-inflammatory medications such as celebrex, arcoxia will help reduce the inflammation

• Physiotherapy

Specifically paying attention to stretching exercises of the ITB and myofascial releases via massages will help to release the ITB especially when tight. Core stability exercises are also of great importance

• Eccentric exercises

Eccentric exercises not only help to stretch out the ITB but also condition it and the rest of the leg muscles to become a controlling force and absorb the forces put through it
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• Cortisone injection

May be indicated and help when the above does not help. Helps relieve the inflammation

• PRP (Platelet Rich Plasma) injections

See section on PRP in Biological healing. Stimulates healing of the inflamed bursa and tendon by injecting growth factors around the area.

• Surgery

In very rare circumstances, surgery may be needed when all the above options have failed. The surgery undertaken is to make a small cut in the ITB which not only releases the ITB but also the friction on the bursa.

Prevention

Prevention is key.

• Gradually build up your exercise intensity and frequency
• Avoiding the exercise that caused it in the first place
• Avoiding running on cambered surfaces
• Correct shoe wear (be careful of being told that you over-pronate and need anti-pronation shoes)
• Stretching the ITB before exercise
• Maintaining a good core stability
• Cross training