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Iliotibial band (ITB) Syndrome

Brad Farra - Thursday, October 08, 2009


I had a patient tell me today that because of me he is back running again and is signed up for an Ironman triathlon next season. Before being treated by me he had other doctors tell him that there is nothing that can be done about his knee and that he should just not run. Iliotibial band (ITB) syndrome should be nothing that keeps you away from running. ITB syndrome can be treated quite successfully.

ITB syndrome is an irritation of a large band of connective tissue that runs from the hip and the tensor fascia lattae and gluteus maximus muscles across the lateral knee to attach below the lateral condyle of the tibia. The pain associated with this can be anywhere along the course of the ITB, but it's usually lateral knee pain. With flexion of the knee the ITB slides over the the lateral distal femur (lateral femoral condyle) and this can cause pain if the ITB is irritated or inflamed due to tension throughout the ITB.

ITB syndrome is very common in distance runners, but can also occur in cyclists. The causes can include but are not limited to: Over training, over pronation and even under pronation due to increased lateral stress on the knee, worn out shoes, hill training, hard surface running, uneven surface running, leg length asymmetry, anterior cruciate ligament laxity, improper use of orthotics, and even weak gluteal muscles.

If you have pain in your knee or hip it is important to have it looked at by a qualified sports physician. Due to the possible contributing factors it's important to consider the entire biomechanical chain when assessing any type of knee pain. This evaluation would include an exam of the low back, hips, knees, and ankles/feet.

Treatment usually includes some type of soft tissue manipulation to the ITB. I use Graston technique (www.grastontechnique.com), but other methods can also be effective. Other treatment would include correction of any biomechanical faults such as over pronation.

Don't let your pain stop you from doing what you want to do!!

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