What is Iliotibial band friction syndrome or ITBFS?
Iliotibial Band Friction Syndrome, or ITBFS for short, is an overuse injury of the knee. It most commonly affects runners and cyclists, as both activities require repetitive bending or flexion and extension movements of the knee, but this condition can develop in anyone.
Iliotibial band friction syndrome symptoms
People with ITBFS feel an ache at the outside of the knee or the outside of the hip. The pain is usually worse with activity and better with rest. People can also experience iliotibial band pain at night as you lay down to sleep and stiffness and tightness is often felt in the morning.
Iliotibial band friction syndrome anatomy
The Iliotibial band or the ITB is a long, broad band of tissue, which runs from the hip down the outside of the thigh. This band travels along the outside of the knee and inserts at the tibia (shin bone). Beneath this band sits a highly sensitive area containing a bursa, a fat pad, blood vessels and nerves. These sensitive structures can easily become irritated and inflamed when this band is tight or is subject to repetitive movements (e.g. running, jumping or cycling).
Overuse is the main cause of ITBFS, so we often see this condition in athletes and those who are very physically active. There are certain other ‘risk factors’ that make ITBFS more likely to develop. You may be more prone to ITBFS if you have the following:
- Muscle imbalance such as weak quadriceps (thigh muscles) and weak hip abductors (inner thigh muscles) or gluteus medius (deep buttock muscles).
- Internally rotated or twisted tibia (shin bone)
- Genu valgum i.e. ‘knock knees’
- Foot mechanics such as over or under pronation (flat feet or high arch feet)
- Worn out or improper shoes
- Inadequate warm-up before exercise
How do I know if I have ITBFS?
There is not one single Iliotibial band friction syndrome test, rather your health professional will usually make a diagnosis based on your symptoms and assessing and palpating (feeling) the affected area.
If the diagnosis of ITBFS is unclear or is not going away with treatment then Iliotibial band friction syndrome MRI can be performed to confirm the diagnosis.
Iliotibial band friction syndrome treatment
Treatment of the acute phase of most injuries generally consists of the following:
Reducing the activity that causes the pain and controlling pain and inflammation using ice or anti-inflammatory medications
Long-term treatment will involve identifying and addressing any issues that may be the cause of your ITBFS. This is done by assessing your biomechanics (i.e. the way that you stand, move and walk). Treatment may involve a combination of the following.
Iliotibial band syndrome stretching
Releasing tight and overworked muscles may be beneficial. Stretches and manual myofascial therapies such as deep tissue massage may reduce muscle tension on the ITB. This will reduce the strain and tightness at the knee.
Iliotibial band syndrome exercises and strengthening
Your podiatrist will prescribe specific exercises in order to strengthen muscle imbalances around the hip and knee.
Footwear
Your podiatrist will assess your footwear and your gait to ensure that your shoes are appropriate for your foot type and requirements.
Orthotics
If your feet are likely to be contributing to the development of your ITBFS then a pair of custom foot orthotics may be required to help manage this incorrect foot function.
Surgery
Surgery is rarely required but may be conducted to release the ITB if conservative treatment fails.
