Iliotibial band syndrome is an overuse injury that affects the outer part of the knee. The iliotibial band is a tendon that connects on the outside of your thigh. It runs from your pelvis down to your tibia and crosses both your hip and knee joints. It assists with both knee extension and flexion as well as provides stability.
Iliotibial band syndrome is more common in runners and cyclists. It is the second most common cause of knee pain and affects up to 12% of runners and 24% of cyclists. It is caused from overuse of the tendon and not from an acute trauma. The iliotibial band is under the most stress when the knee is flexed at 30 degrees. For runners, this position occurs during foot strike and for cyclists it is the lowest point of the pedaling rotation.
A risk factor for developing Iliotibial band syndrome is weak hip abductors. If you have “knock-knees” you have weak hip abductors. Weak hip abductors are more common in women and people who are new to running. If you have “bow-legs” then you have an increase in hip abduction and this is also a risk factor. Hip abduction is most commonly seen in distance runners. Other risk factors include decreased calf muscle flexibility, significant difference in leg length, sudden increase in running distance, improper measurement of bicycle fit which causes incorrect pedal positioning, hill work in cycling and exercising in cold weather.
If you think you may have IBS a simple exam can diagnose it. Reproducing knee pain while you are in certain positions can confirm IBS. Diagnosis is made with exam findings and your history of pain and imaging is not needed. Treatment plans made specifically for you can include local anesthetic injections with lidocaine. The acute phase of treatment includes controlling your pain and requires rest from the activity that is causing pain. This phase also includes injections, ice and non-steroidal anti-inflammatory medications such as Advil or Aleve.
The second phase of treatment can occur from 1 week to several weeks after initial diagnosis. This phase includes assessing your strengths and weaknesses. You can begin activity in this phase which can include swimming and stationary bike with little resistance. This phase not only includes assessing strengths but also flexibility. Therapy at this phase will also incorporate stretching and foam rolling.
The last phase is determined once pain during regular daily activity is resolved and weaknesses and flexibility have been addressed. This phase includes gently returning to your sport. It is okay to have some mild pain at this phase but our goal is less than or equal to 4 out of 10. If pain persists or worsens then an additional rest period will be recommended. Runners can sometimes initially run a decreased pace to avoid pain. Cyclists can adjust saddle height and distance to avoid pain.
Our goal is to help you return to the activities that you love. We will address your pain and incorporate a strength and mobility program tailored to your needs. A complimentary exam can diagnose your Iliotibial band syndrome and begin your healing process.
