Banarsidas Chandiwala Institute of Physiotherapy: ITB Syndrome- A Review in Evidence

Iliotibial (IT) band syndrome is defined as the non-traumatic overuse injury of the knee caused by repeated flexion and extension of the knee that creates irritation in the structures around the knee.

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IT band is a group of fibers that runs through the length of the upper leg, from the hip to the top of the shin.
When overused, the IT band can become tightened. This tightening may cause the band to rub against the outside of the knee. The rubbing can lead to pain and swelling.
IT band syndrome may begin slowly as mild pain and intensify if left untreated.

Causes

Iliotibial band syndrome happens most often in long-distance runners, bicyclists, & other athletes who do repeatedly squats.

The iliotibial band syndrome may be the result of a combination of issues, including:

- poor training habits,

- poor flexibility of muscle, and

- other mechanical imbalances in the body, especially involving the low back, pelvis, hips, and knees.

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Sign and Symptoms of ITB Syndrome

Sign & Symptoms of IT band syndrome may vary slightly from person to person in the intensity and how they appear.

Some symptoms include:

- pain while running or doing other activities involving the outside of the knee

- a clicking sensation felt where the band rubs against the knee

- lingering pain after exercise

- the knee is tender to touch- tenderness in the buttocks

- redness and warmth around the knee, especially the outer aspect

Symptoms usually begin at a short period of time after starting the physical activity.

The most common symptom of IT band syndrome is pain on the outside of the knee, which may get worse if the person continues the activity causing the pain.

Role of Physiotherapy

Treatment of ITB Syndrome is usually non-operative, and physiotherapy should be considered the first and the best line of treatment.
The best exercises to start will depend on the causative factors obtained from the subjective and objective assessment of the patient.

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If the gluteal muscles of the lateral aspect are found to be weak or are functioning improperly, this will result in compensatory muscle adaptation which can lead to excessive contraction of the iliotibial band.
If the gluteal groups are too short, external rotation of the leg can occur and create abnormal stress on the iliotibial band.
Myofascial treatment could be very effective in reducing the pain experienced in the acute phase.

The trigger points in the muscles- biceps femoris, vastus lateralis, gluteus maximus, and tensor fascia lata muscles will be addressed by a myofascial treatment.
The use of a foam roller on tight muscles could also be beneficial. The patient can also perform exercises using a foam roller at home to create deep transverse friction, massage, and stretching of the muscles.

A possible exercise is to lie on the side with the foam roller positioned perpendicular to the bottom leg, just below the hipbone.
The upper leg should be positioned in front for balance. Using the hands for support, roll from the top of the outer thigh down to just above the knee, straightening the front leg while doing the movement.
Exercises to strengthen the abductor muscles and stabilize the hip can be helpful if clinically indicated.

Since ITB syndrome can often be associated with hip abductor weakness, strengthening, and stabilizing of the hip will be beneficial in the treatment of ITBS.

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Some useful exercises

Hip hikes to strengthen the gluteus medius helps to stabilize the hip.
Stand on the edge of a step with the majority of the body weight on the unaffected area.
Lower the hip of the involved hip and bring it back to the neutral position.
Another example- is the side-lying hip abduction exercise with the back against a wall and the leg held at approximately 30° of hip abduction with slight hip external rotation and neutral hip extension.
This exercise can be made more strenuous by placing a 1-meter-long band between the ankles.
Other exercises that are recommended are, the ‘single-leg step down’, the ‘single-leg wall squat’, and the ‘single-leg deadlift.