Iliotibial Band Syndrome: What is it and how can Physio help?
Iliotibial band syndrome (ITB syndrome) is a common condition affecting runners, cyclists, and other athletes. It can be frustrating and painful, but with the right approach, recovery is possible. In this article, we’ll dive into what ITB syndrome is, what it feels like, the causes, and how physiotherapy can help you get back on track.
What Is Iliotibial Band Syndrome?
Iliotibial band syndrome occurs when the Iliotibial band (ITB), a thick band of tissue running from your hip to the knee, becomes irritated or inflamed. This band helps stabilise the knee, but when it’s overused or tight, it can rub against the outer part of the knee, causing pain and swelling.
What Does ITB Syndrome Feel Like?
ITB syndrome usually presents as pain on the outside of the knee. The pain often starts gradually and worsens with activity, especially repetitive motions like running. It might feel like a sharp, stabbing sensation, particularly when the heel strikes the ground, or a persistent ache that doesn’t go away after exercise. Some people describe it as feeling like it is getting tighter and tighter while running, to the point where it feels like it is going to “snap”. Although it may feel like this at times, it is important to remember that the band is very strong and stable.
What Causes ITB Syndrome?
Iliotibial band syndrome can be triggered by various factors, often related to rapid increase in training load and biomechanical imbalances. Training errors are often the primary causes, making up around 84% of ITB syndrome cases. Common training errors include:
rapid increase in volume of training,
rapid increase in running distance or pace,
sudden change in running environment.
Poor biomechanics is another common contributor. Issues such as weak hip and leg muscles, poor alignment of the knee and foot, and poor running technique can alter the way your body moves, increasing the strain on the ITB. For example, if your hip muscles are weak, your knee may collapse inward during movement, placing extra compression on the ITB where it attaches to the knee.
Inadequate footwear also plays a role in ITB syndrome. Wearing shoes that are old, worn out, or lack proper support can change how your foot strikes the ground, affecting your overall alignment and increasing stress on the ITB. Choosing the right shoes, tailored to your foot type and activity level, is crucial in minimising this risk.
Suddenly increasing your running distance, speed, or frequency without allowing your body to adapt can overload the ITB. Running on sloped or uneven surfaces can further aggravate the condition because of the uneven distribution of forces across the band. Particularly, sudden addition of running downhill places more stress on the ITB. Ensuring a gradual increase in training intensity and incorporating adequate recovery time are essential preventive measures.
How to Rehab Iliotibial Band Syndrome
Rehabilitation for ITB syndrome focuses on reducing pain, improving strength and motor control, and correcting any underlying biomechanical issues. Here are some key steps involved in rehab:
Rest and Activity Modification: Initially, you may need to reduce or modify activities that trigger your pain, such as running. Opt for low-impact exercises like swimming or cycling on a stationary bike to maintain fitness without aggravating your symptoms.
Address Running Technique: Improving your running technique can play a crucial role in reducing strain on the iliotibial band and preventing the recurrence of ITB syndrome. Faulty running mechanics, such as overstriding, excessive hip drop, or inward knee collapse, can contribute to ITB irritation. A physiotherapist can assess your running form and identify any problematic patterns that may be increasing stress on your knee.
Key adjustments may include shortening your stride to reduce the impact on your joints, increasing your cadence (steps per minute) to promote smoother movements, and focusing on a midfoot strike to improve stability. Your physio may also recommend specific drills or cues to help retrain your running form, ensuring that your body moves more efficiently and safely as you return to regular training.
Strengthening Exercises: Strengthening weak muscles around the hips and thighs, is essential in managing iliotibial band syndrome. Weakness in these areas can lead to poor control of leg movements, causing the knee to collapse inward and increasing tension on the IT band. A tailored strengthening program can help address these imbalances and support proper alignment during activity.
As your strength improves, you’ll progress to more dynamic movements that mimic the demands of running. Consistency with these exercises not only helps resolve current symptoms but also builds resilience, reducing the risk of future flare-ups.
Gradual Return to Activity: One of the key aspects of rehabbing iliotibial band syndrome is addressing training errors, particularly if a sudden increase in running intensity or distance contributed to your symptoms. A gradual load plan is essential to help you safely return to running without overloading the IT band.
Start by reducing your current training volume and intensity, replacing running with low-impact activities like swimming or cycling. Once your symptoms have settled, slowly reintroduce running with a structured plan, beginning with short, easy runs on flat surfaces. Gradually increase your mileage by no more than 10% per week, and avoid any sudden changes in speed, terrain, or frequency.
Working with your physiotherapist to create a personalised plan can ensure you're progressing at the right pace, minimising the risk of re-injury and allowing your body to adapt safely.
Can a Physio Help ITB Syndrome?
A physiotherapist can be instrumental in the recovery from ITB syndrome. The first step is a comprehensive assessment where the physio evaluates your overall movement patterns, muscle strength, flexibility, and biomechanics. They will likely assess how your hips, knees, and feet move in relation to each other during activities like walking, running, or squatting. This assessment helps pinpoint any weaknesses, tightness, or alignment issues that may be contributing to your symptoms.
A key focus during this assessment is on muscle strength testing, particularly around the hips and glutes. Weakness in these areas can lead to poor control of your leg movements, increasing strain on the ITB. The physio will look for imbalances in muscle strength that may be causing your knee to move inward or your hip to drop, both of which can exacerbate ITB syndrome.
Exercise rehabilitation forms a cornerstone of physiotherapy for ITB syndrome. The physio will design a tailored exercise program to address your specific weaknesses and imbalances.
Physiotherapists also work on improving biomechanics through movement retraining. They may guide you through techniques to adjust your running form, for instance, to reduce the stress on your ITB. This could include changing your stride, cadence, or foot strike pattern to better align your lower body during activity. Alongside exercises, a physio may use manual therapy techniques such as soft tissue massage, trigger point release, or dry needling to relieve muscle tightness and promote healing.
Can You Stretch the Iliotibial Band?
Gentle stretching can help improve flexibility around the hip, thigh, and knee. However, it is important to note that stretching the ITB itself is not recommended. This is because the ITB is such a tough structure, it can not be stretched. Attempting to do so will not provide any change in it’s flexibility and can place additional compression to the ITB attachment, which can exacerbate the symptoms.
How Long Does It Take for ITB Syndrome to Go Away?
The recovery timeline for ITB syndrome can vary significantly depending on the severity of the condition, how early it is diagnosed, and the effectiveness of the management approach. For mild cases, where pain is only just starting to interfere with activities, recovery might take as little as four to six weeks with consistent rehab and rest. During this time, reducing or modifying aggravating activities and sticking to a structured rehab program can lead to significant improvements.
However, more severe or chronic cases, where the pain has persisted for months or the ITB is highly inflamed, may take longer to resolve. In such instances, it might take several months of diligent rehabilitation before a full return to normal activities is possible. Key factors influencing the recovery rate include adherence to your physio’s exercise program, making necessary adjustments to your training routines, and being mindful of any flare-ups that could set back your progress.
In some cases, external factors such as underlying biomechanical issues, poor movement patterns, or inadequate footwear need to be addressed for long-term success. Regular follow-ups with your physiotherapist are crucial to monitor progress, adjust the rehab program as needed, and ensure you’re on the right track. Patience and consistency are essential; while setbacks can occur, working closely with your physiotherapist and following their guidance will give you the best chance at a full and lasting recovery.
Conclusion
Iliotibial band syndrome can be a painful setback, but with the right treatment approach, you can get back to your favorite activities. Physiotherapy plays a critical role in managing ITB syndrome by addressing the root causes and helping you build a strong foundation for recovery. If you’re struggling with persistent knee pain, consider booking an appointment with a physiotherapist to start your journey towards pain-free movement.
Our articles are not designed to replace medical advice. If you have an injury or health concern, we recommend seeing a qualified health professional.
