Iliotibial Band Syndrome

with Rehab

The iliotibial (IT) band is a tendon that connects the hip muscles to the shinbone (tibia) and to one of the bones of the pelvis (ileum). The IT band passes by the knee and is often irritated by the outer portion of the knee (lateral femoral condyle). A fluid filled sac (bursa) exists between the tendon and the bone, to cushion and reduce friction. Overuse of the tendon may cause excessive friction, which results in IT band syndrome. This condition involves inflammation of the bursa (bursitis) and/or inflammation of the IT band (tendinitis).

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the IT band, at the outer knee (above the joint).

  • Pain that travels up or down the thigh or leg.

  • Initially, pain at the beginning of an exercise, that decreases once warmed up. Eventually, pain throughout the activity, getting worse as the activity continues. May cause the athlete to stop in the middle of training or competing.

  • Pain that gets worse when running down hills or stairs, on banked tracks, or next to the curb on the street.

  • Pain that increases when the foot of the affected leg hits the ground.

  • Possibly, a crackling sound (crepitation) when the tendon or bursa is moved or touched.

CAUSES

IT band syndrome is caused by irritation of the IT band and the underlying bursa. This eventually results in inflammation and pain. IT band syndrome is an overuse injury.

RISK INCREASES WITH:

  • Sports with repetitive knee-bending activities (distance running, cycling).

  • Incorrect training techniques, including sudden changes in the intensity, frequency, or duration of training.

  • Not enough rest between workouts.

  • Poor strength and flexibility, especially a tight IT band.

  • Failure to warm up properly before activity.

  • Bow legs.

  • Arthritis of the knee.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper training technique, including reducing running mileage, shortening stride, and avoiding running on hills and banked surfaces.

  • Wear arch supports (orthotics), if you have flat feet.

PROGNOSIS

If treated properly, IT band syndrome usually goes away within 6 weeks of treatment.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated, or if not given enough time to heal.

  • Recurring inflammation of the tendon and bursa, that may result in a chronic condition.

  • Recurring symptoms, if activity is resumed too soon, with overuse, with a direct blow, or with poor training technique.

  • Inability to complete training or competition.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. For individuals with flat feet, an arch support (orthotic) may be helpful. Some individuals find that wearing a knee sleeve or compression bandage around the knee during workouts provides some relief. Certain training techniques, such as adjusting stride length, avoiding running on hills or stairs, changing the direction you run on a circular or banked track, or changing the side of the road you run on, if you run next to the curb, may help decrease symptoms of IT band syndrome. Cyclists may need to change the seat height or foot position on their bicycles. An injection of cortisone into the bursa may be recommended. Surgery to remove the inflamed bursa and/or part of the IT band is only considered after at least 6 months of non-surgical treatment.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Iliotibial Band Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Iliotibial Band

  • On the floor or bed, lie on your side, so your right / left leg is on top. Bend your knee and grab your ankle.

  • Slowly bring your knee back so that your thigh is in line with your trunk. Keep your heel at your buttocks and gently arch your back, so your head, shoulders and hips line up.

  • Slowly lower your leg so that your knee approaches the floor or bed, until you feel a gentle stretch on the outside of your right / left thigh. If you do not feel a stretch and your knee will not fall farther, place the heel of your opposite foot on top of your knee, and pull your thigh down farther.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Iliotibial Band Syndrome

Improving the flexibility of the IT band will best relieve your discomfort due to IT band syndrome. Strengthening exercises, however, can help improve both muscle endurance and joint mechanics, reducing the factors that can contribute to this condition. Your physician, physical therapist or athletic trainer may provide you with exercises that train specific muscle groups that are especially weak. The following exercises target muscles that are often weak in people who have IT band syndrome.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles. Poor form means that you are not strengthening the correct muscles.

  • Lie on your side, so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4-6 inches, leading with your heel. Be sure that your foot does not drift forward and that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting (you may not notice this until your leg begins to tire).

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quad/VMO, Isometric

  • Sit in a chair with your right / left knee slightly bent. With your fingertips, feel the VMO muscle (just above the inside of your knee). The VMO is important in controlling the position of your kneecap.

  • Keeping your fingertips on this muscle. Without actually moving your leg, attempt to drive your knee down, as if straightening your leg. You should feel your VMO tense. If you have a difficult time, you may wish to try the same exercise on your healthy knee first.

  • Tense this muscle as hard as you can, without increasing any knee pain.

  • Hold for __________ seconds. Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.