Sports performance especially with activity that involves running is directly affected by symptoms of Iliotibial Band Syndrome. This overuse injury occurs when the iliotibial band becomes tight and inflamed.
The iliotibial band runs along the outside of the thigh from the hip and attaches to the knee thus helps stabilize and move the knee joint. When the ITB becomes tight, knee movement in sports performance activity becomes painful.
At first many athletes experiencing pain from the iliotibial band think that it is a knee injury but this syndrome is external of the knee joint. ITBS is commonly seen in runners, cyclists, hikers and athletes that suddenly increase their level of activity.
Here we will discuss the causes, symptoms, treatment and prevention of this common ailment and its affect on sports performance.
X-rays of the area will most likely be negative. MRI studies will show evidence of thickening of the band and possible scar tissue formation from inflammation. The best way of diagnosing ITB syndrome is to ask the patient to bend the knee to a 45 degree angle; if pain is noted along the outside of the knee the condition is quite evident.
The common symptoms of ITBS are (1) pain along the lateral aspect of knee joint (2) swelling and tenderness along the outside of knee and (3) a snapping or popping sensation with knee bend. Any of these symptoms will impede the sports performance of the athlete.
When the distal iliotibial band causes excessive friction sliding over the knee joint with repetitive motion; inflammation arises resulting in pain and decreased sports performance.
Some of the causes of ITBS are (1) decreased flexibility and strength of the quadriceps muscle (2) abnormal tilting of pelvis possibly from a curvature of spine (3) bowl legs and (4) pronated feet.
All of these symptoms result in excess stretching of the ITB causing overuse. The syndrome results also from sports performance activity that repeatedly turns the leg inward such as running downhill, running all the time in the same direction and running for mileage. Wearing worn out sneakers is also a big factor with the onset of this condition. The condition is more prevalent in women because women’s hips tilt in a way that cause knees to rotate in.
The first step to reduce the acute symptoms of ITBS is to start ice applications on a daily basis, rest and anti-inflammatory medication. Once the acute symptoms subside physical therapy can begin.
Sports rehabilitation protocol focuses on increasing the flexibility and strength of the hip and knee. Proper stretching and strengthening with ITBS is always beneficial under the guidance of a physical therapist.
Modalities such as electrical stimulation, ultrasound and cold laser are used to reduce inflammation, sensitivity and tenderness. Iontophoresis and phonophoresis can be used here to drive cortisone cream into the area by electrical stimulation or ultrasound.
Orthopedic surgeons as a last resort can inject the band with a corticosteroid but it is not their preference because ITB is a tendon not a joint.
Here are ways to prevent ITBS (1) rest for a few days from activity and decrease running mileage when you experience pain along the outside of knee (2) warm up by walking before running (3) make sure your sneakers are not worn out (4) avoid concrete surfaces (5) try to run in the middle of the road where it is flatter (6) always change direction when running on a track and (7) see if you need orthotics by seeing a podiatrist.
With proper treatment, home stretching/strengthening program and education patients can return to their normal sports performance activities (with modifications) within a matter of weeks.