Iliotibial Band Friction Syndrome

Iliotibial Band (ITB) Friction Syndrome is a common knee injury that occurs on the outside of the knee. The iliotibial band is a thick band of fascia that starts near the hip joint and extends down the outside of the thigh, to insert on the outside edge of the shin bone (tibia) just below the knee joint. The ITB becomes inflamed from rubbing against the femur (thigh bone) on the outside of the knee.

Typically the symptoms are swelling and pain on the outside of the knee. The pain is aggravated by running downhill or activities that require repetitive knee flexion and extension. The pain may start as a dull ache and if not treated, progress to a sharp pain.

ITB syndrome is caused by friction of the distal aspect of the ITB as it slides back and forth over the bony prominence on the outside of the knee (lateral femoral epicondyle). This friction occurs around 30º of knee flexion and repetitive flexion and extension of the knee results irritation to the ITB. Some factors that may cause this irritation include:

• Excessive ITB tightness.
• High weekly running distance, frequency, intensity.
• Weakness of the muscles that extend and flex the knee.
• Weakness of hip abductors.
• Excessive foot pronation (rolling in of ankle).
• Poor footwear.
• Running on hard and bank surfaces

Once symptoms of ITB syndrome begin they can further aggravated by activities such as:

• Running down hills.
• Climbing stairs.
• Walking after sitting for long periods with the knee flexed.

At Mint Foot Care, we diagnose this condition by taking a comprehensive history, performing a biomechanical assessment and video gait analysis. The podiatrist may prescribe diagnostic imaging such as an MRI.

Based on the findings a combination of treatment options may be prescribed including:

• Rest and Ice – keeping off the foot and reducing activity prevents further injury and encourages healing. Ice can reduce inflammation, swelling and symptoms.
• Non-steroidal anti-inflammatory medication – help reduce the pain and inflammation such as ibuprofen or aspirin.
• Proper fitting and supportive footwear recommendations.
• Custom made orthotic therapy – orthotics may be prescribed to address any biomechanical factors such as over pronation.
• Exercises to strengthen the muscles within the quadriceps group and hip abductors.
• Stretching to address ITB tightness.
• Dry Needling.
• Ultrasound therapy.

Patients who do not respond to conservative therapy, surgery may be required to release and stabilise the ITB.