Iliotibial Band Syndrome

Iliotibial band syndrome is a condition that usually presents as pain on the outside of the knee. There is debate about the exact nature of the condition. Previously we believed that it was a friction syndrome, caused by rubbing over the bony part of the outside of the knee. More recently, however, we now understand that it is more of an impinging of the tissue at the side of the knee ⁽¹⁾. This is important as it changes how we look to manage and ultimately resolve, the condition.

There are a number of possible causes of the condition but the most common are;

• Hip muscle weakness – weakness of the hip muscles can increase the stress on the outside of the knee, particularly when you are fatigued from exercise ⁽⁴⁾.
• Excessive training load – training load that your body is not accustomed to, or training that involves a significant amount of volume without sufficient rest, can cause a number of overuse conditions, in particular iliotibial band syndrome ⁽⁷⁾.
• Poor running technique – typically running with what is termed a crossover gait can increase the load to the iliotibial band.
• Poor foot mechanics – excessive or poor control of pronation (the way your foot and arches flatten to distribute force when landing) of the foot can also increase the load on the structure due to an increase of internal rotation of the tibia.

Iliotibial band syndrome is very rarely seen in the general population. It is one of the most common injuries in runners presenting with lateral knee pain, with an incidence estimated to be between 5% and 14% ⁽²⁾. Further studies indicate that iliotibial band syndrome is responsible for approximately 22% of all lower extremity injuries ⁽⁹⁾.

A musculoskeletal physiotherapist can provide you with an accurate and timely diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities. Any tests we do will be considered alongside your symptoms to ensure we have an accurate working diagnosis

Your physiotherapist will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

It is rarely necessary in this condition to require any scans or X-rays to be done immediately as physiotherapy will most likely be the first line of treatment. If symptoms persist or get worse then an MRI scan may be used to understand what else could be causing the symptoms.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your iliotibial band syndrome. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

This condition is common in runners but the success rate of treatment through physiotherapy is very high. In most cases, it will be possible to return to a normal level of activity on completion of a course of physiotherapy.

Typically, exercise is the best strategy for dealing with iliotibial band syndrome. In the past, it was believed that techniques such as massage and ultrasound to the iliotibial band itself were effective. However, recent research brings this assumption into question.

Local use of radial shockwave therapy (RSWT) is believed to stimulate the healing of soft tissue and reduce the activation of pain receptors. Radial shockwave therapy has been shown to be effective as part of a rehabilitation programme for runners with iliotibial band syndrome ⁽⁸⁾.