IT Band Syndrome is a non-traumatic overuse injury that often occurs in patients between 15-50 years old who are active and in particular, do a lot of running or biking. The IT band becomes tight and rubs against the lateral epicondyle of the femur as the knee flexes and extends. You can also experience this same pain over the greater trochanter at the hip as this is where the IT band runs. IT band syndrome is diagnosed by history and physical examinations taken by a health care professional.
Pain over the outside of the knee that will gradually increase over a few days to weeks, as well as pain when touching the outside of the knee on the affected side. This pain will be more noticeable when performing activities such as running, in particular when the heel strikes the ground. This pain can radiate to the outer thigh and calf in certain cases.
You may also notice a squeaking sound coming from your knee when bending and straightening in some cases.
The IT band itself will be tender to touch at the knee. Pain over the greater trochanter if the IT band is affected at the hip. In the beginning, the pain will start to occur post-exercise, but as the IT Band starts to become more irritated it will start to flare up early in the activity or when you are at rest.
What are common causes of IT Band Syndrome?
Common causes of IT band syndrome include:
Repetitive flexion and extension of the knee, as commonly seen in running and biking. Biking with your seat too high or having an improper orthotic fit in your running or everyday footwear.
Mechanism of Injury is most commonly overuse due to running/biking.
Other common associations include limb length discrepancies.
Outward bowing of the legs
Overpronation of the feet
Hip abductor muscle weakness and myofascial restriction.
If affected at the hip with hip flexion, the IT band slides forward over the greater trochanter and may cause a painful click or pop. In a recent study, patients with IT Band syndrome had less hip adduction and frontal range of motion (ROM) in their hip joints than people without IT band syndrome. Hip flexion and knee flexion were also significantly reduced.
Glute max and TFL issues or injuries in the past may also play a role.
Does IT Band Syndrome go away? How long does it take to recover from IT Band Syndrome?
Many people find that their symptoms respond well to conservative care such as heat application, massage and following instructions to stretch and avoid downhill running for the next 3 weeks. As always, individual recovery can vary and it’s best to discuss your specific case with your health practitioner.
Complications are rare, however lower limb biomechanics abnormalities can occur if the IT band syndrome is chronic and the patient is compensating by overusing other muscles.
IT band syndrome often won’t improve without being proactive with activity modification and stretching during the rehab/acute portion of your recovery.
What shouldn’t you do if you have IT band syndrome?
You shouldn’t continue to perform downhill running, as this is the most likely thing to aggravate IT band syndrome. Neglecting it and believing the issue will go away by itself is also something to avoid.
What should you do if you have IT band syndrome – what may help with IT band syndrome?
Heat and ice may be helpful within the early, acute stage of the injury. Lay on your side and apply heat to the lateral aspect of the thigh with a pillow between your legs.
Stretching exercises for the IT band and surrounding muscles (such as glute med, TFL, hamstrings, calves and hip flexors – in particular, iliopsoas). Perform both static and active stretches roughly 3 times a day. Work on hip mobility and ROM exercises. Foam rolling the IT band itself may also be beneficial.
Massage the muscles like the IT Band, TFL and glute med.
Regular Chiropractic adjustments to help support the function of the joints around the IT band.
Modify choice of exercise and go for non-weight bearing exercise like swimming, rather than biking and running to avoid further aggravation. For athletes, it may be worth considering changing the training program to allow time for adequate recovery.
Visit an orthotics specialist to get orthotics installed into running shoes or find a pair of running shoes that compliment your style of running.
If there is no improvement in 6-8 weeks, you should get an ultrasound or MRI to assess for potential ligament damage or impingement.
Can Chiropractic care help with IT Band syndrome? How?
When treating IT band syndrome, Chiropractic care may be a helpful part of supporting the prognosis and the rehab of the injury. Your Chiropractor will assess the affected area and look for key signs of IT band syndrome – this includes over-pronation of the affected leg, as well as signs of inflammation around the affected knee joint due to friction of the lateral epicondyle.
A postural/gait analysis will be performed to see how you are aligned and how this could be affecting the IT band.
Your Chiropractor will take the knee through the full range of motion and be looking for pain at certain angles and positions indicative of IT band syndrome. Full Hip ROM will also be performed as the IT band originates from your hip.
Your Chiropractor will also perform orthopaedic tests (such as Ober’s) to assess for dysfunction with the IT band.
Regular checks to the pelvis and lumbosacral joints for joint dysfunction, especially at the site of the TFL attachment. Test the hip abductor muscles for weakness. The Chiropractor will assess and, where appropriate, adjust around your pelvis/SI joints, as well as the knees and feet on the affected side to help support the function of the lower limb.
To summarise, IT band syndrome may respond well to conservative care such as Chiropractic, stretching, heat and ice application. As with any condition, we recommend discussing your individual circumstances with your Chiropractor or health practitioner.
REFERENCES
Farooq, S., & Hacking, C. (n.d.). Iliotibial band syndrome | Radiology reference article | Radiopaedia.org. Radiopaedia.org, the wiki-based collaborative Radiology resource. Retrieved October 1, 2020, from https://radiopaedia.org/articles/iliotibial-band-syndrome
Lavine R. Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine, 2010; 3(1-4):18–22
Rosenthal, M. D. (2008). Clinical testing for extra-articular lateral knee pain. A modification and combination of traditional tests. North American journal of sports physical therapy: NAJSPT, 3(2), 107.
Baker RL, Fredericson M. Iliotibial Band Syndrome in Runners: Biomechanical Implications and Exercise Interventions. Physical médicine and réhabilitation clinics of North America, 2016; 27(1):53-77
Martinez, J., & Lorenzo, C. T. (2016). Physical Medicine and Rehabilitation for Iliotibial Band Syndrome. Medscape, LLC, 825.
Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. American Family Physician. 2005;71(8):1545-1550.
Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport, 2007; 10:74-76
van der Worp MP, van der Horst N, de Wijer A, Backx FJ, Nijhuis-van der Sanden MW. Iliotibial Band Syndrome in Runners. Sport Medicine, 2012;42(11):969-92.
Weckström, K., & Söderström, J. (2016). Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome. Journal of back and musculoskeletal rehabilitation, 29(1), 161-170.
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