Iliotibial Band Friction Syndrome

Posted on 26 May 2009 01:23






By Musculoskeletal Consumer Review

Tell any long-distance runner or cyclist about your stinging pain at the side of the knee or hip, and you will get a knowing sympathetic look. ITB (Iliotibial band) friction syndrome is one of the commonest complaints amongst runners, cyclists and intense court sports.

ITB friction syndrome gets its name from the Iliotibial Band rubbing against a bony protrusion just at the side your knee. The ITB is a continuation of one the largest hip muscles and spans as a thick band of tissue on the outside of the thigh. Starting from the pelvis, it runs over side of the hip and ending just below the knee. Just before it crosses the knee, it runs over a protrusion in the thigh bone (lateral femoral epicondyle). The frequent rubbing of the band over this bony protrusion from bending and straightening of the knee irritates the band, causing an inflammation. The tighter the ITB, the harder it rubs over the protrusion.

What tightens the ITB?

Three basic things tighten the ITB.

1. Training methods
2. Bio-mechanical gait issues
3. Weak outer thigh muscles1

Training Methods

Running on banked surfaces, inadequate warm up or cool down, increases in distance too fast or excessive downhill running are faults associated with running which strains the ITB. In cycling having the feet toed inwards commonly causes the band to get tight.

iliotibial band over lateral femoral epicondyle protrusion

Bio-mechanical Gait

Problems with foot structures such as high or low arches and uneven leg length typically tighten the ITB on one side. A complete biomechanical assessment helps determine the faults. Where appropriate, foot orthotics can correct these problems.

Weak outer hip muscles

Weak outer hip muscles forces the ITB to work harder to compensate and becomes tight as a result. Exercise to strengthen the outer hip muscles helps to lighten the load on the ITB (see footnote 1).

Despite avoiding all the three issues mentioned, athletes with a high training volume often still experience painful ITBs. In such cases, deep tissue massage will help release the tight band.

Don’t forget to stretch the ITB. Ignoring ITB tightness can lead to groin pain and low back pains.

This work by Musculoskeletal Consumer Review is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License.

Circular Tracks

Circular tracks, similar to crowned surfaces at the sides of roads, are another contributer to iliotibial band problems. If you are one of those people who runs around those short tracks at places like Bally's and you are experiencing chronic ITB problems, this may be the problem, or part of it.

Foam Rolling.

The article doesn't mention self myofasical release. If you can't afford a professional deep tissue treatment this is the way to go. Another advantage of self myofascial release of the iliotibial band is that it can be performed more often and on your own schedule.

Foam works great for the ITB. Can be followed by stretches which helps or the two can be used in conjunction. But deep tissue massage or self myofascial release in general is the most effective for directly treating the iliotibial band.

You may also want to work on the hot spots separately with a tennis or lacrosse ball, a massager such as The Stick, or a Thera Cane. It is difficult to do with your own fingers and apply enough pressure.

The tensor fascia latae should also be worked in conjunction with the itb band. The tensor fascia lata inserts into the band and if it is overworked due to weak hip abductors the iliotibial band is overworked but the TFL will need to be treated as well.

The TFL is at the top of the leg in the notch created between the outer hip bone and the upper thigh. You'll be working this at when you do the foam rolling but I have always found a foam roller to be ineffective for this. I recommend The Stick to roll this portion more effectively. You may find some trigger points in this area, one just in front just below the hip bone and another an inch or so to the outside, according to the Trigger Point Therapy Workbook.

This area and it's trigger points can also be worked very effectively with a tennis ball or lacrosse ball against a wall. Or, of course with a theracane.

Work on activating the medial glutes by using exercises such as X Band Walks and use various single leg movements. Often in these cases "weak" does not mean weak from a relative strength perspective but rather it means "inhibited". So you shouldn't have to wait weeks and weeks to see a strength and hypertrophy effect in the abductors to see results. You just want to get the medial glutes firing.


Foam Rolling for the ITB

You will find very tender hot-spots. You can use short concentrated strokes over this area or pause before continuing with normal rolling. Keep in mind that the evidence for foam rolling for ITB "release" is anecdotal. However, while it has been reported that there is evidence that it does not work, this evidence raises a question as to whether the proposed mechanism for foam rolling the ITB is possible, which does not directly provide evidence of the ineffectiveness of foam rolling to provide relief, not that it is dangerous.

You will find very tender hot-spots. You can use short concentrated
strokes over this area or pause before continuing with normal rolling
. Keep in mind that the evidence for foam rolling for ITB "release" is anecdotal. However, while it has been reported that there is evidence that it does not work, this evidence raises a question as to whether the proposed mechanism for foam rolling the ITB is possible, which does not directly provide evidence of the ineffectiveness of foam rolling to provide relief, not that it is dangerous.


Stretch for the ITB


X Band Walk

Activates and strengthens the hip abductors - medial glues



This page created 26 May 2009 01:23
Last updated 03 Jun 2016 22:52

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