Injury Tip Sheet: IT Band Syndrome
Learn what you need to know about ITBS
Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
- More common in runners and cyclists
- Represents 12% of overuse injuries in runners
- 50% of ITBS sufferers run between 20 and 40 miles per week
- First described in sports literature in 1975
What you need to know
What is the IT band?
- The iliotibial (IT) band is a thick band of tissue located on the outside of the leg. The IT band begins at the upper hip, extends down the outside of the thigh and connects with the tibia just below the knee.
- Together with the thigh muscles, the IT band stabilizes the knee and helps the hip muscles with abduction or an outward movement of the leg
- Is an inflammation or irritation to this band of tissue
- More prevalent in runners with weaker hip flexors and gluteal muscles
- Commonly mistaken for a lateral knee injury.
Signs & symptoms
- Iliotibial Band Syndrome (ITBS) can cause pain at the origin at the upper hip (ilium), the lateral hip as it crosses the boney prominence of the hip (greater troch), the lateral knee as it crosses the lateral condyle, or its insertion on the tibia.
- ITBS usually starts as tightness in the outer knee area and if not treated progressively worsens. In some causes the pain can be severe and inhibits the individual from participating in their sport.
- Pain is typically felt on the outside of the knee or lateral hip and is exacerbated by movement and often relieved by rest or inactivity.
- The tightness of the band can often result in clicking noises as the band moves back and forth over the hip or lateral knee.
When should I see a medical professional?
- You should visit a sports medicine physician if the pain and swelling do not subside after rest, icing, and IT band stretching.
- A focus physical exam is typically all that is required to make the diagnosis. It is uncommon to need further tests such as an MRI to make the diagnosis.
- Your physician will either have you perform a focused home exercise program or prescribe physical therapy specifically designed for stretching and strengthening exercises.
- Corticosteroid injections may be necessary in recalcitrant cases.
- Surgery is rarely needed.
- ITBS is a common overuse injury that can results from repetitive motion and a lack of hip stability and flexibility of the IT band.
- ITBS can be caused by anatomical and biomechanical factors such as leg length differences, over-pronation, weakness in the hip flexor and gluteus medius muscle, and other muscle imbalances.
- Overtraining, increased mileage, dramatic increases in the intensity of a workout.
- Inadequate footwear and decreased lower extremity flexibility and strength can cause additional stress on lower extremity muscles that can contribute to the stress placed on the IT band.
- Mechanical gait problems, running on slanted surfaces or on hills.
- High mileage runners or runners who drastically increase their mileage.
What you can do
- Adequate stretching prior to and after workouts, especially long training runs, are an important part of preventing ITBS.
- Distance running often causes more stress to the IT band than speedwork. If you are a runner, walker, or cyclist an important part of your routine training should include stretching and strengthening of the ITB, hip flexors and gluteus medius muscle.
- Additionally, make sure that you increase your mileage gradually and ensure that your footwear has appropriate lateral (side to side) support.
Recommendations for treatment and rehab
- ITBS is initially treated by addressing strength and flexibility deficits of the trunk and lower extremity muscles as well as addressing biomechanical faults that may be contributing to muscle imbalances.
- It is common for those recovering from ITBS to reduce their high impact workouts to place less stress on the IT Band.
- Mild cases of ITBS can be relieved with icing, stretching, strengthening, over the counter anti-inflammatory medications, and active rest.
- Massage therapy can also be helpful in releasing some of the tension along the band. Foam rollers can be used in lieu of a professional massage therapist and are also helpful in stretching exercises.
- If ITBS results from a gait issue such as leg length difference, orthotics or heel lifts may be necessary.
What can I do to stay active?
- Avoid activities that aggravate the injury.
- Runners may participate in aqua jogging or cycling if this does not increase pain.
- Cyclists or runners also may do well using the elliptical trainer as another form of cardio training.
For more information on ITBS and common knee injuries, see the following articles:
Fullem, Brian, D.P.M. Beating the Band: New Treatment for IT Band Syndrome Yields Results. (As featured in the May 2004 issue of Running Times Magazine. http://runningtimes.com/Article.aspx?ArticleID=3528