ITB Syndrome

Iliotibial band syndrome (ITBS) is a common overuse/overload injury that affects runners, cyclists and other athletes who engage in repetitive knee movements. ITBS is caused by the irritation and inflammation of the tissue under the iliotibial band. The iliotibial band is a thick band of tissue that runs from the hip to the knee on the outside of the thigh. It can compress the tissues on the outside of the knee leading to pain.

While ITBS is often referred to as “runner’s knee”, it is not the same as other types of knee injuries such as patellofemoral pain syndrome or meniscal tears. It may coexist with patella femoral or fat pad pain.

Iliotibial band syndrome (ITBS) is not due to rubbing of the ITB but more likely compression of the tissues that sit on the outside of the knee joint. Imaging can show inflammation in this area. While the focus has often been on stretching a tight ITB that is not the real issue. More often the ITB is tightened by over-activity in the muscles attaching to it, in addition poor control around the hip and pelvis, weakness of postural controlling muscles and/or over-development of the outer part of the quad muscle. Footwear and foot position can also contribute, as can running style.

If you are experiencing episodes of pain on the outside of the knee during sports or hiking (especially downhill) then try the following:

• Rest your affected leg and avoid any activities that cause pain or discomfort.
• Apply ice to the affected area for 15-20 minutes at a time, several times a day.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage pain and inflammation.
• Modify your training. Consider whether a change in shoes or bike setup could have contributed.

With rest, the symptoms settle frequently. If this is the case, try to reintroduce your sports or activity gently. Sometimes ITBS will have settled but in many cases the underlying reasons for the condition persist so you will need assessment and treatment. That may initially be with a physiotherapist, but if you continue to have pain in spite of seeing a physio then seek further advice. ITBS tends to benefit from early intervention which may shorten recovery period.

Treatment options for ITBS knee

• Physiotherapy is the mainstay treatment. They may suggest an assessment for orthotics for your footwear and/or recommend your bike setup is looked at if it troubles you when cycling. You may take anti-inflammatory medications.
• Injections of steroid can be extremely effective and, when combined with physiotherapy, may sort out the problem for good.
• Surgery is effective in those who find the effect of an injection wears off. A minor operation under local anaesthetic can be highly effective in those that have failed other treatments.

I have successfully treated patients with ITBS for more than 20 years. The vast majority are treated without surgery. I am referred patients from far afield who have failed non-surgical care. By using a small local anaesthetic procedure I have helped amateur and elite runners, soldiers, cyclists, footballers and walkers return to activity from ITBS. Even in the most difficult cases I aim to get you back to your sports.