Iliotibial band friction syndrome

Most runners will experience some level of discomfort in the side of their thigh at one time or another. A dull, annoying pain which can extend from the hip joint to the knee, but most commonly presents as a sharp lateral knee pain.

The ITB, is formed by the gluteus maximus muscle posteriorly (behind!) and the tensor fascia latae anteriorly (front), the two muscles joining together just below the hip joint (greater trochanter – bony part of the hip) and from here create a thick, strong band that supports the knee.

Interestingly, it is distance running (more than 5km) that will most often aggravate the ITB, and this is due to the slower, more repetitive nature of distance running and therefore the angle of the thigh in relation to the knee. It is easy to imagine irritation occurring with a prolonged activity in a relatively small range, and it is thought that this constant rubbing of the tendon across the bony part of the knee (lateral epicondyle) aggravates the bursa (fluid filled sac) which acts as a cushion between the ITB and the bone.

Other contributing factors include, poor footwear, excessive pronation o the feet, tight quadriceps, other muscular imbalances around the hip and lower back. Most often however, excessive training loads, or sudden changes in training regimes, do not allow the relevant structures to adapt, and as a result irritation and pain can develop.

The symptoms therefore give rise to the management. Anti-inflammatory medication can assist the bursa irritation; however it is essentially a biomechanical problem. Stretching of the gluteals and hip flexors (front of the hip) as-well as specific ITB stretching will assist. A great trick is to apply direct pressure to the band by laying on either a rolled up towel, tennis ball or Pilates ‘roller’ which encourages a ‘release’, and finding those points that are most problematic.

Myotherapy treatment would involve a biomechanical and posture analysis, massage therapy, ultrasound and sports taping to the ITB directly and possibly to any other contributing imbalances, such as the quads or gluts etc. Footwear and therefore lower limb biomechanics may need addressing and referral to a podiatrist can be useful.

In addition to home based exercises, regular icing is useful to decrease the inflammatory properties; core ad peripheral strengthening exercises should assist in preventing the condition from re-appearing and aiding tolerance of running related stresses. 

Simon Pastoors Myotherapy
Camberwell Road Podiatry
402 Camberwell Road, Camberwell