Iliotibial Band Syndrome in Runners

Innovations in Treatment

Abstract

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners. It is an overuse injury that results from repetitive friction of the iliotibial band (ITB) over the lateral femoral epicondyle, with biomechanical studies demonstrating a maximal zone of impingement at approximately 30° of knee flexion. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running. Studies have also demonstrated that weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilise the pelvis and eccentrically control femoral abduction. As a result, other muscles must compensate, often leading to excessive soft tissue tightness and myofascial restrictions. Initial treatment should focus on activity modification, therapeutic modalities to decrease local inflammation, nonsteroidal anti-inflammatory medication, and in severe cases, a corticosteroid injection. Stretching exercises can be started once acute inflammation is under control. Identifying and eliminating myofascial restrictions complement the therapy programme and should precede strengthening and muscle re-education. Strengthening exercises should emphasise eccentric muscle contractions, triplanar motions and integrated movement patterns. With this comprehensive treatment approach, most patients will fully recover by 6 weeks. Interestingly, biomechanical studies have shown that faster-paced running is less likely to aggravate ITBS and faster strides are initially recommended over a slower jogging pace. Over time, gradual increases in distance and frequency are permitted. In the rare refractory case, surgery may be required. The most common procedure is releasing or lengthening the posterior aspect of the ITB at the location of peak tension over the lateral femoral condyle.

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Notes

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    Please keep in mind the range of motion and rotation will vary for each exercise depending upon the runner’s ability to eccentrically load through the three planes of motion, especially the frontal and transverse planes. This action will become greater as the person improves range of motion, which will inherently and functionally improve strength.

References

  1. 1.

    Barber FA, Sutker AN. Iliotibial band syndrome. Sports Med 1992; 14 (2): 144–8

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Clement DB, Taunton JE, Smart GW, et al. A survey of overuse running injuries. Phys Sportsmed 1981; 9 (5): 47–58

    Google Scholar 

  3. 3.

    Linderburg G, Pinshaw R, Noakes TD. Iliotibial band syndrome in runners. Phys Sportsmed 1984; 12 (5): 118–30

    Google Scholar 

  4. 4.

    Noble CA. Iliotibial band friction syndrome in runners. Am J Sports Med 1980 Jul-Aug; 8 (4): 232–4

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Evans P. The postural function of the iliotibial tract. Ann R Coll Surg Engl 1979 Jul; 61 (4): 271–80

    PubMed  CAS  Google Scholar 

  6. 6.

    Orchard JW, Fricker PA, Abud AT, et al. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med 1996 May-Jun; 24 (3): 375–9

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med 1986 Jan-Feb; 14 (1): 39–45

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Martens M, Libbrecht P, Burssens A. Surgical treatment of iliotibial band friction syndrome. Am J Sports Med 1989 Sep-Oct; 17 (5): 651–4

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Gottschalk F, Kourosh S, Leveau B. The functional anatomy of tensor fascia latae and gluteus medius and minimus. J Anat 1989 Oct; 166: 179–89

    PubMed  CAS  Google Scholar 

  10. 10.

    Messier SP, Edwards DG, Martin DF, et al. Etiology of iliotibial band friction syndrome in distance runners. Med Sci Sports Exerc 1995 Jul; 27 (7): 951–60

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 2000 Jul; 10 (3): 169–75

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    MacMahon JM, Chaudhari AM, Adriacchi TP. Biomechanical injury predictors for marathon runners: striding towards iliotibial band syndrome injury prevention [abstract]. Hong Kong: International Society of Biomechanics, 2000

    Google Scholar 

  13. 13.

    Schwellnus MP. Lower limb biomechanics in runners with the iliotibial band friction syndrome, abstracted. Med Sci Sports Exerc 1993; 25 (5): S68

    Google Scholar 

  14. 14.

    Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore (MD): Williams & Wilkins, 1999

    Google Scholar 

  15. 15.

    Fredericson M, Guillet M, DeBenedictis L. Quick solutions for iliotibial band syndrome. Phys Sportsmed 2000; 28: 52–68

    Article  Google Scholar 

  16. 16.

    Kendall FP, McCreary EK, Provance PG. Muscles: testing and function. 4th ed. Baltimore (MD): Williams & Wilkins, 1993

    Google Scholar 

  17. 17.

    Janda V. Muscle function testing. London: Butterworths, 1983

    Google Scholar 

  18. 18.

    Gray G. Total body functional profile. Adrian (MI): Wynn Marketing, 2001

    Google Scholar 

  19. 19.

    Nishimura G, Yamato M, Tamai K, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997 Sep; 26 (9): 533–7

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Wolf C. IDEA. Personal Trainer Magazine 2002; Jul–Aug: 20–31

  21. 21.

    Fredericson M, White JJ, MacMahon JM, et al. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Arch Phys Med Rehabil 2002 May; 83 (5): 589–92

    PubMed  Article  Google Scholar 

  22. 22.

    Richards DP, Barber FA, Troop RL. Iliotibial band Z-lengthening. Arthroscopy 2003 Mar; 19 (3): 326–9

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Dr Michael Fredericson.

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Fredericson, M., Wolf, C. Iliotibial Band Syndrome in Runners. Sports Med 35, 451–459 (2005). https://doi.org/10.2165/00007256-200535050-00006

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Keywords

  • Knee Flexion
  • Lateral Femoral Condyle
  • Gluteus Medius
  • Tensor Fascia Lata
  • Lateral Femoral Epicondyle