Iliotibial band syndrome or ITB syndrome is thought to be the second most common complaint of distance runners, this is why it is known as runners knee. The number one most common injury is patellofemoral pain syndrome, and in my opinion the two go hand in hand.
Running itself I feel is very hard to get right, and this is supported in the literature with studies finding that the annual injury incidence rate of some part of the lower limb for runners is as high as 74%. This is super high, you can pretty much say that most runners get injured, and the most likely place that they get injured is the knee. The knee accounts for up to 42% of all running injuries! A lot of people (around 2 million to be precise-ish) look at running as a great way to increase cardiovascular fitness and help with weight control, and so it is a shame to hear that most people find themselves injured! This blog post aims to look at the whys and hows of ITB syndrome (and a bit of pat-fem syndrome) in an attempt to give you sound advice to shave off a few percentages…or just be the 26% of uninjured runners bounding around our streets.
So what is it?
ITB syndrome is described as pain on the lateral (outside) part of the knee. The pain is not associated with any trauma, usually begins a few kilometres in to a run and gets worse as the run continues. Interestingly ITB syndrome is twice as likely to affect women as men, bad times ladies.
But what is this iliotibial band that you speak of?
The iliotibial band begins at your gluteus maximus (your buttock) and something called the tensor fascia lata (sort of the side of your bottom), this means it has connections as high up as the top of your pelvis and even blends in to the capsule of the hip joint…it then continues down the outside aspect of your femur as a strong band of connective tissue until it reaches the knee joint where it has several attachments to the knee joint- both above and below, even having some attachments to the patella (don’t tell me pat-fem syndrome and ITB don’t talk!)2.
And what does it do please?
The IT band is thought to resist hip adduction when in mid stance- in plain English, this means that the IT band stops your hip dropping out to the side when you are stood on one leg. Considering the attachments of the IT band to the pelvis, hip and knee joint, this makes sense and clearly performs an important role during walking- otherwise we would be swaying from side to side very unsteadily. Now consider running…and specifically heel strike running. Heel strike running is in effect fast walking, with much higher impact and greater speed, straight away we can see the potential for something to get over loaded here.
But that’s just a thought. Moving on.
What causes injury or irritation to the ITB?
Compression or friction are two theories floating about amongst literary circles…
Earlier researchers thought that the ITB was effectively getting friction burn from sliding over a bony prominence (the lateral femoral condyle if you’re interested) on the outside of the knee. However, this has been disputed by more recent researchers who argued that the ITB is not a loose structure and so unlikely to be sliding over anything. Instead, these researchers found that at about 30 degrees of knee flexion the ITB compresses against a bony prominence of the knee joint. Makes sense doesn’t it? Except that people who don’t have ITB syndrome have been found to have this too, which makes things a bit confusing. It doesn’t make the friction or compression theories redundant, but it doesn’t prove a clear cause for ITB syndrome either.
Differences in running biomechanics has been proposed as a factor in the development of ITB syndrome. People with ITB syndrome were found to move more through their trunk, and less through their hips, possibly as a mechanism to control pain, or possibly as the cause of pain. People who ran with this pattern had harder IT bands and this could be predisposing them to have the friction/compression type problems outlined above. Considering this research, strengthening lower extremity musculature and ensuring proper trunk movement during running are good rehab proposals for those of you suffering with ITB syndrome3.
One of the latest suggestions of an explanation for ITB syndrome is that some people have a capsular recess (an extra bit of knee joint capsule) that extends under the IT band. This can become inflamed and irritated giving the symptoms of ITB syndrome too3.
What can osteopathy do to help?
So as an osteopath I can… have a good look at your active and passive movements to see if I can see anything that predisposes your ITB to irritation. I can examine your posture for the same thing. I then tailor a treatment from what I have found in order to take the strain off the ITB. I often find that a good treatment through the gluts, ITB, soft tissues around the knee, the calf muscles, lower back, spine and pelvis can get an ITB feeling a hell of a lot better. I feel that osteopathy is absolutely fantastic for relieving the pain of ITB syndrome, but it is critical that it doesn’t stop there…
Osteopathy alone is never as strong as osteopathy with rehabilitation and movement education with David Lees (http://www.pinnacleperformanceswansea.com) or Beth Cox (http://yogapractice.co.uk/) . I will always recommend going to see one of these two, they are both extremely well equipped to rehab you to a point where you don’t see your ITB syndrome coming back, or at the very least have some form of control over it. These two will give you the tools to stretch, strengthen and/or mobilise as appropriate to improve what you have got. This step is critical, unless you want to be coming to see me forever, and that costs ££. ££ that you could be spending on holidays… or new running shoes for that matter…but if you want to buy me new running shoes, I’m not saying no.
- Associations between iliotibial band injury status and running biomechanics in women Eric Foch a, *, Jeffrey A. Reinbolt b , Songning Zhang a , Eugene C. Fitzhugh a , Clare E. Milner a
- The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners e A systematic review of the literature Maryke Louw*, Clare Deary
- The Source of Fluid Deep to the Iliotibial Band: Documentation of a Potential Intra-Articular Source Elena J. Jelsing, MD, Eugene Maida, MB, ChB, Jonathan T. Finnoff, DO, Jay Smith, MD