With the summer weather fast approaching and running/cycling season in full force here in the city of Toronto, one common injury that will present in our physiotherapy clinic is Iliotibial band syndrome. The annoying pain that affects the outside of the knee results from a little too much, too soon. Read below to find out more about this injury, how you can treat it yourself, and what we can do for you.
What is Iliotibial Band Friction Syndrome?
IIliotibial band friction syndrome (aka IT band friction syndrome) is a common overuse injury to the lateral (outside) aspect of the knee. The IT band is a thick band of fascia (connective tissue) which runs from the pelvis, over the hip and down to just below the lateral aspect of the knee.
With activities involving repeated bending and straightening of the knee, a tight IT band can create a lot of friction and compression of the underlying tissues, particularly at the bony prominence on the outside of the knee called the lateral femoral condyle. Over time, this friction can cause inflammation and pain.
What Symptoms are Associated with IT Band Friction Syndrome?
The most common symptom associated with IT band friction syndrome is lateral knee pain, often experienced as a sharp, burning or stinging pain. Generally, the pain is brought on by an activity involving repeated bending and straightening of the knee, and it may get worse during the length of the activity until rest is allowed. Sometimes, if inflammation is present, the pain will remain for a period of time after the aggravating activity has stopped. Usually rest will allow the pain to resolve, although if the underlying cause of the pain is not addressed, it will continue to come back when you return to the aggravating activity.
Some common aggravating activities include:
- Hopping and Jumping
What Causes Iliotibial Band Friction Syndrome?
There are several factors that can contribute to the development of IT band friction syndrome.
The following is not an exhaustive list but it includes some of the more common factors, which we have control over:
- People with tight IT bands are more likely to experience the above symptoms because a tight IT band creates more compression of the underlying tissues.
- Weakness or imbalances in hip musculature can also be a big contributor to this condition, as the muscles around the hip are extremely important for proper knee alignment and tracking.
- Excessive foot pronation can also alter the mechanics of the knee and increase the friction under the IT band.
- General overuse such as performing an activity without proper training, over-training, or training in an imbalanced or poorly aligned way can also contribute to the development of IT band friction syndrome.
How can a Physiotherapist and/or Chiropractor Help with Iliotibial Band Friction Syndrome?
If you suspect you may have IT band friction syndrome, it would be a good idea to book an assessment with a registered physiotherapist and/or chiropractor. Overall, they will help you speed up recovery time and get you back to the activity you enjoy.
Often, the root cause of IT band friction syndrome is not in the knee but stems from elsewhere in the chain. Your physiotherapist or chiropractor will thoroughly assess you to determine the source of your pain and also the root cause of why you are experiencing it. They will educate you so that you can understand what is going on, what caused it and they will develop a treatment plan to help reduce your pain and address the problem.
Treatment plans will include rehabilitative exercises, myofascial release, manual therapies and education. There may also be a mix of therapeutic modalities including acupuncture, cupping or dry needling in addition to hands on manual therapy. They may also recommend a referral for massage therapy, custom orthotics or a sports medicine physician consult.
What Should be Avoided with Iliotibial Band Friction Syndrome?
If you do have IT band friction syndrome, it is recommended, at least initially, that you stop or reduce any aggravating activities as much as possible to avoid further injury.
Try not to sit cross legged. This may tighten the muscles in the hips and pelvis.
You also want to avoid waiting too long to get it assessed if your own attempts do not alleviate your pain, get the help you need to get out of the vicious cycle of inflammation that your tissue is experiencing.
How can you Treat Iliotibial Band Friction Syndrome at Home?
If you are just experiencing the onset of symptoms or have caught it early enough you may be successful with the following strategies.
When you are inflamed or aggravated from an activity be sure to ice with some compression over the area for 10min ON/OFF up to 3x. This will help to control the chemical process that occur with inflammation.
Check your Running Shoes
Ensure that your shoes are providing the proper support for your feet. If you have flat feet and tend to over pronate you may need to use a stability shoe that supports your arch during your activity. If your shoes are well worn and the surface of the sole has changed, it may be time to replace them.
Modify Activities and Cross Train
Make sure you stop the activity or decrease the intensity or duration to prevent the pain/inflammatory cycle. You may choose another activity that does not cause the symptoms to worsen, such as strength training, yoga, Pilates or swimming with just using arms for cardiovascular fitness.
Strengthen and Stretch
Depending on the root cause of your IT band pain your exercise program will vary, this is why it is important to consult with a Physiotherapist and or Chiropractor. See below for some suggested exercises.
What are the Best Exercises to do with Iliotibial Band Friction Syndrome?
Stretch the IT Band
To stretch your IT band, cross the foot of the leg being stretched across your body. Then take your arm on the same side and stretch it overhead and across as well. This will make a large C curve with the affected side of your body. Keep your pelvis still and level and feel the stretch from your hip towards your knee.
Hold 30 sec repeat 3x twice a day.
Release the IT Band
To release the IT Band, try yoga tune up balls and/or a foam roller. Place them under your outside thigh while lying on top of them on the floor. Roll over the IT band, lingering longer on the more painful tighter areas.
Perform for a few minutes up to twice a day.
Strengthen the Gluteal Muscles and Core
Lying on your back with your knees bent and feet flat. Placing most of the weight in your heels lift your pelvis off the floor.
Hold 5 seconds repeat 10x up to three time a day.
To progress and challenge your core further perform this exercise with one leg straight and only one leg lifting your body. In this positon it is important that you keep your pelvis squared to the ceiling.
The bird dog is a a stability exercise that trains your core, glutes, abdominal, upper back, lower spine, hamstrings and hip muscles.
How Long Does it take to Recover from Iliotibial Band Friction Syndrome?
Recovery from this soft tissue injury should take about 6-8 weeks, provided you have modified your lifestyle and have participated in your active exercise program regularly. In certain cases, recovery and return to sport may take less time and in more severe cases it could take longer. Overall, it is really important that you seek the professional help you need as soon as you recognize that your condition is not resolving. You do not want to delay and miss out on the limited time we have to spend outside during summer in our beautiful city.
Rebalance Sports Medicine has some excellent physiotherapists, chiropractors, sports medicine physicians and massage therapists who would be happy to help you with your knee pain and answer any questions you might have. We also have therapists that specialize in running injuries and are highly educated to get you back to running faster. Please do not hesitate to contact us and book an assessment today.
Written By: Reanna Montopoli, FCAMPT Physiotherapist