Introduction
IT band, or the Iliotibial band, is a thick fibrous tissue that runs along the lateral aspect of the thigh and firmly inserts in the anterolateral part of the proximal tibia. IT band is not exactly a single band with two areas of attachment; instead, it has more layers intertwined with other tissues all the way down the outside of the thigh and several muscles attached. The iliotibial band greatly affects a person’s gait and stability.
What Is IT Band Syndrome?
IT band continues the TFL (tensor fasciae latae) muscle. It extends, abducts, and laterally rotates the hip, contributing to lateral knee stabilization. During running, the repetitive motion of flexing and extending the knee can lead to impingement of the iliotibial band as it moves back and forth across the lateral femoral epicondyle. The impingement usually occurs at approximately 20 to 30 degrees of knee flexion. Subsequently, the surrounding tissue gets inflamed and irritates the soft tissues and bursa, the small fluid-filled sac reducing friction between the joint and becoming painful.
What Are the Risk Factors for IT Band Syndrome?
IT band syndrome most commonly occurs in long-distance runners, cyclists, and other athletes undergoing repetitive knee flexion and extension exercises.
Factors that predispose runners to iliotibial band syndrome include:
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Overtraining or training too hard and not giving the muscles enough time to recover.
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A recent increase in distance.
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Sudden change in running style.
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Downhill running can increase the drop on the pelvis or impact forces on the leg.
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Overpronation of the Leg- The foot turning in excessively while running can cause strain to the IT band.
Other predisposing factors causing IT band syndrome are:
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Weakness of the hip abductor muscle causes increased internal rotation and knee adduction.
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Leg length discrepancy-when one leg is longer than the other leg, causes strain to the iliotibial band.
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Certain anatomical factors, such as bowed legs and flat feet.
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Presence of knee arthritis.
What Are the Symptoms of IT Band Syndrome?
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The most crucial symptom of IT band syndrome is a vague pain on the lateral sides of the knee which may spread up or down the leg and occasionally the hip.
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The symptoms may be mild in the beginning and will progress over time.
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Runners may experience sharp pain outside their knee that may progress to lingering pain on excessive running.
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As the disease progresses, the pain can occur with walking and without activity.
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Pain may radiate up the lateral thigh and to the distal tibia.
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Symptoms can present as point tenderness at the lateral femoral condyle. Hence the patient may present with abnormal gait since they avoid knee flexion.
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Rarely do patients with IT band syndrome present with swelling on the side of the leg. A patient may experience snapping or clicking sounds outside of their knees.
How Is IT Band Syndrome Diagnosed?
The health care provider or the physical therapist will diagnose the IT band syndrome by conducting a clinical examination. The doctor will interview the patient regarding the history and clinical symptoms. Pain on palpation of the IT band at the lateral femoral condyle may be present. Patients will be asked to perform various movements- pain may be reproduced by doing a single leg squat. The doctor may perform multiple provocative tests to diagnose the IT band syndrome, such as:
Ober’s Test:
The Ober’s test is a clinical examination used to assess the tightness of the iliotibial band.
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The patient should lie on the side with the affected leg up.
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With the knee flexed and the hip fully extended, the examiner will gradually move the leg outward in an abduction motion.
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When the IT band is tight, adduction of the leg is limited as the leg will not touch the other knee, and the patient will experience lateral knee pain, and the test is considered positive.
Noble Test:
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The examiner performs the noble test by placing the thumb over the iliotibial band before its insertion into the gerdy’s tubercle of the lateral tibia with the knee flexed to 90 degrees.
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With pressure placed into the IT band, the leg is extended.
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If the pain is felt at around 30 to 70 degrees of flexion, It is considered positive and is often referred to as a “painful arc.”
When the diagnosis is still unclear, the doctor may perform radiographic investigations to rule out other differential diagnoses, such as osteoarthritis of the knee, lateral meniscus tear, and other knee injuries. For example, MRI (magnetic resonance imaging) may show evidence of thickened iliotibial band and edema deep into the iliotibial band.
How Is IT Band Syndrome Treated?
With conservative management, IT band syndrome typically resolves the pain within six to eight weeks. The first line of control in IT band syndrome is reducing the training load and correcting the predisposing factors. Patients are asked to avoid the inciting activities until the pain is resolved- Avoiding sports activities such as running and cycling may trigger the IT band syndrome. Relative rest from running and high flexion and extension of the knee.
Inflammation reduction is made using oral NSAIDs (non-steroidal anti-inflammatory drugs), which are not advised for more than ten days. Locally administered anti-inflammatory drugs, such as topical Diclofenac sodium patches, have been used. Local infiltration of corticosteroids is done to reduce inflammation over the joint.
Physiotherapy plays a significant role in treating patients with IT band syndrome. Stretching exercises for the ITB and adduction strengthening exercises such as:
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Two-man Ober stretch.
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Self-Ober stretch.
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Lateral fascial stretch.
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Posterior fascial stretch plus gluteus maximus and piriformis self-stretch.
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Standing wall lean for lateral fascial stretch.
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Iliopsoas with rectus femoris self-stretch.
Intermittent cryotherapy is advised (icing the area before and after exercise). Ultrasound and electrotherapies to reduce tension over the Iliotibial band. Myofascial release therapy is used to release the tightness over the IT band.
Leg length discrepancies can be treated by heel lift and using specific insoles in the shoe. Patient education on proper posturing is essential in preventing IT band syndrome from reoccurring. Surgery is advised in rare cases.
How to Prevent IT Band Syndrome?
Preventing IT band syndrome is very important for athletes and other long-distance runners.
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Stretching and strengthening exercises for hip flexor muscles.
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Stretching the hamstring muscles and thigh muscles regularly.
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Giving the body enough time to recover during training.
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Properly stretching and doing warm-ups before and after running.
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Avoid running on uneven surfaces.
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Use soft, new running shoes rather than hard shoes.
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Use of lateral heel wedge in shoe for iliotibial band tightness.
Conclusion
Nearly 20% of endurance athletes experience this painful condition of Iliotibial band syndrome. Physical therapy and other treatments and exercises can bring the patients to a complete recovery phase with minimal time away from the training. The earlier they seek treatment, the sooner they can return to normal activities. Patients can prevent the recurrence of IT band syndrome through stretches and strengthening workouts for the leg.
