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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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.
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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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Fredericson, M., Wolf, C. Iliotibial Band Syndrome in Runners. Sports Med 35, 451–459 (2005). https://doi.org/10.2165/00007256-200535050-00006
- Knee Flexion
- Lateral Femoral Condyle
- Gluteus Medius
- Tensor Fascia Lata
- Lateral Femoral Epicondyle