What is Iliotibial Band Syndrome?
Iliotibial band syndrome (ITBS) is a common knee injury that usually presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line and inferior to the lateral femoral epicondyle. It is considered a non-traumatic overuse injury and is often concomitant with the underlying weakness of hip abductor muscles. This repetitive motion causes excessive friction between the lateral femoral epicondyle and the iliotibial tract.
What are the causes of Iliotibial Band Syndrome?
The etiology of Iliotibial Friction Syndrome is often multifactorial. Activities with repetitive flexion and extension of the knee can cause the iliotibial band to rub repeatedly along the lateral femoral epicondyle producing irritation and eventually an inflammatory reaction of the iliotibial band. Muscle weakness of the hip abductors is also be associated with iliotibial band syndrome as this causes increased hip internal rotation and knee adduction. Other proposed etiologies for IT band syndrome include compression of the fat and connective tissue that is deep then the IT band, as well as chronic inflammation of the IT band bursa.
How can physiotherapy help treat Iliotibial Band Syndrome?
The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment.
Activity modification to prevent further aggravation of the patient’s symptoms should be the first area to be addressed in treatment. Patients should be advised to participate in other physical activities, such as e.g. swimming, that do not aggravate their symptoms but all of them to maintain their conditioning.
Modalities to provide pain relief include ice (cryotherapy) or heat, Ultrasound therapy providing thermal or non-thermal treatment of the injured tissue can also assist in reduction of inflammation.
Type of exercises
– Exercises to increase mobility to the iliotibial band and related structures is a main focus aiming to reduce frictioning of the band against the lateral epicondyle of the femur.
– Exercises to strengthen the abductor and gluteal muscles assisting in hip stabilisation..
Some examples of useful exercises:
- Hip hikes to strengthen the gluteus medius help stabilize the hip. Stand on the edge of a step with the majority of the body weight on the unaffected side. Lower the hip of the involved hip and bring it back to neutral.
- side-lying hip abduction exercise with the back against a wall and the leg held at approximately 30° of hip abduction with slight hip external rotation and neutral hip extension. This exercise can be made more strenuous by placing a 1-meter-long band between the ankles.
- Other exercises that are recommended, given the relationship of lowering body weight on one leg and neuromuscular control, are the ‘single-leg step down’ the ‘single-leg wall squat’ and the ‘single-leg deadlift’ Hip/knee coordination and running/cycling style modification through the increase of neuromuscular control of gait.