Health & Safety Spotlight
Iliotibial Band Syndrome: Symptoms, Causes, Treatment By Stephen M. Pribut, DPM Iliotibial band (ITB) syndrome is one of the top 10 injuries seen in distance runners. Weak hip abductor muscles play a large role in the development of ITB syndrome. These weak hip abductors are part of a commonly seen pattern of weak core muscles, which leads to a muscle imbalance. On longer runs, and as you are just starting to increase the length of your runs, your hip abductors can become fatigued and require the added assistance of the muscles which attach into the ITB, requiring them to work harder. It seems that this sequence of events may lead to increased tension in the ITB, causing the injury. Strengthening the hip abductors and stretching the ITB and structures that attach into it are usually the keys to recovering from this problem. Symptoms of the iliotibial band syndrome include pain or aching on the outer side of the knee. This usually happens in the middle or at the end of a run. A concomitant problem may occur at the hip called greater trochanteric bursitis. During flexion and extension of the knee, the iliotibial band has historically been thought to rub over the femoral condyle, creating irritation. There’s significant doubt about this being a true “friction”-created syndrome. In most cases, ITB syndrome does not seem to be a friction syndrome with a “popping” of the tendon over the femoral epicondyle. Most runners do not report a “popping” feeling. Instead, there’s a compression in this region that most often affects the fat tissue overlying the femoral epicondyle. I believe there’s significant tension developed during the stance phase of the running gait that results in a tendinopathic tendon. Other authors have found some evidence for this. Fairclough has raised the question, “Is the iliotibial band syndrome really a friction syndrome?” He contends that the ITB is firmly attached to the femur and is not anatomically capable of moving forward and backward over the lateral epicondyle of the femur. Recent cadaver studies and MRI studies have failed to document the expected evidence for friction or for a primary anatomical bursa. Instead, an area of compression seems to be present in the fat tissue that lies over the lateral femoral epicondyle. Weak hip abductors, especially the gluteus medius, are often found. Some other factors that may contribute to this syndrome include genu varum (bow legs), pronation of the foot (subtalar joint pronation), leg length discrepancy, and running on a crowned surface. We need to emphasize that over the past few years an association with weak glu-
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Possible Causes of ITB Syndrome -Hip abductor muscle weakness and imbalance -Weak core muscles -Sudden increase in mileage -Increase in track or interval training -Crowned running surface -Tight iliotibial band -Tight hip capsule, tight latissumus dorsi, and side muscles
Self-Treatment for ITB Syndrome -Temporarily decrease or halt your training. -Do side stretches. -Strengthen your hip abductors (gluteal muscles, especially the gluteus medius). This is critical. -Try gentle foam rolling (not too hard a roller and not too painful). -Avoid crowned surfaces or too much running around a track. -Shorten your stride. -While shoes may not be as important a contributing factor as was once believed, you may want to try a change. Motion control shoes are not likely to be the answer. -Carefully examine your training regimen. If you’ve been keeping a running diary, check it for possible training errors.
teus medius muscles has been found in many runners with ITB syndrome. The weakness of the gluteal muscles causes more tension to develop in the iliotibial band as the muscles inserting into it have to assist in keeping the hips level. The function of the muscles inserting into the ITB (tensor fascia lata) is to abduct the leg. If the hip abductors are weak, then the ITB is being overworked. The ITB does not have an insertion that offers a favorable mechanical advantage. In fact, it’s at a considerable disadvantage for the purpose of hip and leg abduction activity. Therefore, when the hip abductors are weak, the tensor fascia lata must contract harder and over a longer time, thus straining the ITB. Make sure that part of your cure is to strengthen your hip and leg abductors. Circular track running may also contribute to ITB, since it stresses the body in a manner similar to that of crowned surfaces and leg length differences. In research performed on track athletes in 2000, circular track running was found to cause asymmetrical muscle strength development. The study didn’t measure ITB and related muscle strength, but found lower down on the leg that the inner leg had stronger inverter strength and the outer leg had stronger everter strength. While it wasn’t studied, the outer ITB would likely be placed under much greater stresses than the inner leg. The angles of force acting on it would be greater by virtue of the leg and pelvis position required to run around an oval track. All factors can be aggravated by a tight iliotibial band. Changes in training may also
contribute to development of ITB syndrome. It’s always important to examine your training regimen and see what alterations have recently occurred. A rapid increase in running distances and times spent running often precedes the development of this injury. Cyclists may develop iliotibial band syndrome from overuse. Changing the position of the cleats by rotating the heels inward can often help. Be certain to check the bike seat to ensure it’s not too high. Additional information about anatomy and recommended stretches and core strength work to assist with ITB issues can be found at www.drpribut.com/sports/spitb.html
Dr. Stephen Pribut is a clinical assistant professor of surgery at the George Washington University Medical Center. A member of the Advisory Board of Runner’s World magazine, he is past-president of the American Academy of Podiatric Sports Medicine and has served as chair of the AAPSM Athletic Shoe Committee for five years. Pribut has served on the Education Committee, the Research Committee, the Public Relations Committee and also chaired the Annual Meeting Committee. He is past president of the District of Columbia Podiatric Medical Association, serving in that post for four years. Pribut has served as a member of the American Podiatric Medical Association’s Clinical Practice Advisory Committee and its Internet Committee.
Winter 2015 ClubRunning • 7
1/21/15 8:29 AM