The popularity of recreational running is sky rocketing with the number of runners coming through the CSSM doors higher than ever.

Iliotibial band syndrome is the most common injury to the outside of the knee in runners with an incidence rate between 5% and 14% (Van der Worp et al, 2014). The ITB is a long fibrous structure that extends from the hip to the knee. Iliotibial band syndrome is caused by friction between the ITB and the underlying bony process of the femur. The highest friction point is at 30 degrees of knee flexion during foot strike and the early stance phase of running. The cause of ITBS is multifactorial involving both intrinsic and extrinsic factors.

Risk factors

  • Downhill running
  • Poor footwear
  • Poor gluteal strength
  • Poor pelvic control
  • Uneven surfaces
  • Running biomechanics
  • Leg length discrepancy

Symptoms

  • An ache and/or tenderness over the outside of the knee
  • Pain onset at about the same time/distance on each run
  • Pain aggravated by running downhill
  • Pain descending stairs

Recent evidence

A recent systematic review has investigated the aetiology, diagnosis and treatment of ITBS in runners.

Iliotibial Band Syndrome in Runners A Systematic Review

Maarten P. van der Worp,1 Nick van der Horst,1 Anton de Wijer,1,2 Frank J.G. Backx3 and Maria W.G. Nijhuis-van der Sanden4

The main results of the study showed:

The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. While articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilisation, exercises to strengthen the hip, and advice about running shoes and running surface.

Management

Here at CSSM we can help!

Clearly the biomechanics of different running styles can contribute to ITBS. With our latest technology we are able to assess your running technique to help treat the cause of your pain. An appropriate rehabilitation program should be prescribed to strengthen and stretch the relevant pre-disposing structures. A podiatry appointment may be necessary to assess foot posture to ensure you are wearing the correct footwear.

If you are experiencing an ache in the outside of the knee, first line treatment is relative rest and ice. However, prevention is always the best cure. If you have any queries, contact any of the friendly practitioners at CSSM for an opinion or advice.