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Causes and management of iliotibial band syndrome

Iliotibial Band Syndrome

There are many types of aches, pains, and dysfunction that can show up in the legs. Many are common overuse types of injuries that often occur in those engaged with specific sports, like running or cycling. In this article we’ll take a look at one of those syndromes, iliotibial band syndrome.

What is iliotibial band syndrome?

Iliotibial band syndrome is the name given to a group of symptoms. They include pain, tenderness, and sometimes swelling, felt usually towards the distal end of the iliotibial band as it crosses the lateral femoral condyle, just proximal to its attachment on the tibia. Remember that the iliotibial band (IT band) is the ligamentous fascia that runs from the tensor fascia latae and gluteus maximus muscles along the lateral thigh and knee to attach to the tibia just below the knee. Researchers have suggested that greater than average ankle pronation, muscle weakness (knee flexors, knee extenders, hip abductors), differences in leg length, and slower paced cadence when running, are all associated with greater likelihood of reporting iliotibial band syndrome (Fredericson and Wolf, 2005).

What causes iliotibial band syndrome?

Iliotibial band syndrome is usually considered an overuse type of injury, rather than an acute type of injury like an accident such as a fall. It often occurs when we over-train in a sport like running or cycling, ramp up in distances too quickly, or simply run or bike with a form that doesn’t work for our body structure. Most commonly, iliotibial band syndrome shows up in runners (or sports that include a lot of running) and cyclists. 

Multiple causes for the specific pain pattern that shows up in iliotibial band syndrome have been suggested, but all of those hypotheses are still being debated among researchers. There is no single agreed upon cause.

Causes that have been suggested and that may contribute to the pain pattern experienced in iliotibial band syndrome include (Charles and Rodgers, 2020):

  • Friction of the IT band on the lateral femoral condyle during running, walking, or cycling
  • Inflammation/bursitis of the IT band bursa
  • Compression of the small layer of fat that acts as a cushion near the IT band distal attachment

How is iliotibial band syndrome managed?

As the causes of the pain symptoms of iliotibial band syndrome are still being debated, so are the best ways to manage this painful set of symptoms. Basic therapeutic treatments for reducing any inflammation that’s present are used first, as are a reduction or temporary elimination of sports or activities that seem to cause the pain symptoms. Following that, the most common treatments are recommended after a thorough examination by a physical therapist. 

Stretching and/or strengthening of muscles might be suggested depending on what your physical therapist finds during the examination. Although it’s been suggested that weakness in the abductors, such as gluteus medius, gluteus minimus, and the tensor fascia latae muscles, contributes to iliotibial band syndrome, and that strengthening one or more of these muscles could help alleviate symptoms, it’s not clear from research whether this is true (Charles and Rodgers, 2020). A recent study of two groups of runners: one group experiencing iliotibial band syndrome and a second asymptomatic group, did not find differences in hip muscle strength between the two groups (Hamstra-Wright et al., 2020). 

However, researchers did find differences in the way that the two groups were using their hips and legs when running (gait patterns) (Hamstra-Wright et al., 2020). One way that symptoms of iliotibial band syndrome is sometimes managed is by having a physical therapist or sport-specific trainer make changes to your form in running or cycling to ultimately change the load pattern in the body. Addressing existing trigger points and other myofascial restrictions is also sometimes recommended to help alleviate iliotibial band syndrome. Only in unusually severe cases are surgical treatments used to manage iliotibial band syndrome.

While there are many benefits to exercise such as running and cycling, we can also sometimes experience injuries and negative impacts. Iliotibial band syndrome is one issue that can arise in those sports in particular. As treatment is specific to each person and their situation, if you are experiencing the painful symptoms associated with iliotibial band syndrome, see an experienced physical therapist for a thorough assessment.

References

Charles, D. and C. Rodgers. 2020. A literature review and clinical commentary on the development of iliotibial band syndrome in runners. The International Journal of Sports Physical Therapy. 15(3):460-470.

Fredericson, M. and C. Wolf. 2005. Iliotibial band syndrome in runners: Innovations in treatment. Sports Medicine. 35(5):451-459.

Hamstra-Wright, K.L., M.W. Jones, C.A. Courtney, D. Maiguel, and R. Ferber. 2020. Effects of iliotibial band syndrome on pain sensitivity and gait kinematics in female runners: A preliminary study. Clinical Biomechanics. 76: 7pgs.

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