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Written by Michael J. Kelo, PT, MPH, OCS
Mike Kelo Physical Therapy, PLLC
Iliotibial band syndrome is so named due to the difficulty in determining whether that specific tissue is the cause of a person’s knee pain, lateral leg pain (outside) and or lateral (outside) hip pain. One can better understand the challenges of identifying and treating this problem by understanding more about the anatomy and function of the ITB and its surrounding muscle tissues.
The iliotibial band (ITB) is a formation of dense connective tissue that originates at the lateral hip/ upper thigh in the area of the large bony prominence at the lateral hip known as the greater trochanter (the hip bone that sticks out) and descends down the outside of the thigh.
How pain in the ITB band can be felt in the knee and in other body parts.
The ITB band acts as an attachment for several muscles, including all rear end gluteus muscles. Some of the hip external rotators are also attached to a portion of the ITB.
These broadly attached structures means the ITB helps to stabilize the hips while walking and running. And based on its lower attachment or insertion into the lateral tibia, just below the knee, it functionally connects the knee to the hip.
Hence, many ITB stretches you may learn should include hip external rotation, which would mean the foot on the side you want to stretch should be pointed outward with toes away from your body. Based on how this muscle is attached, the ITB is shortened during hip abduction, or moving the hip and leg away from the midline of the body. Again, the opposite motion, hip adduction, or movement of the leg and hip toward or across the midline of the body stretches the ITB.
ITB Tightness can cause patellar knee problems
Because the lower fibers of the ITB blend into the ligaments and attach to the outer border of the knee cap (patella), problems can arise in the trochlear groove— the place on the femur between two bony ridges, which holds the kneecap in place. Over time, this can cause arthritis at the patellofemoral joint (PFJ).
If the forces are dramatic, the knee cap can move partially out of the PFJ. This is called a subluxated patella. If the forces are extreme then you can have a lateral patellar dislocation.
IT Band Friction Syndrome
Some people have a lot of ITB tightness combined with other factors which causes what is known as distal IT Band Friction Syndrome (ITBFS).
Effective strategies may include: Ice, anti-inflammatory medication, modalities such as iontophoresis, phonophoresis.
Stretching and manual soft tissue mobilization should be a consideration but the professional treating you needs to understand well which stage of inflammation and recovery you are in so as not to worsen inflammation with manual soft tissue massage, mobilization techniques or with stretching.
Another component of ITB syndrome is lateral hip pain, which is pain on the side of the hip.
The ITB can be so tight that people with this problem feel a “popping or snapping”. In this condition, the lateral gluteal muscles are very tight as well. This can be so painful, patients come into the office saying, “My hip is dislocating!” This problem will many times be diagnosed as ‘trochanteric bursitis’ as the surrounding bursa tissue, which is supposed to act as a low friction lubricating structure starts to get inflamed and become a source of increasing friction and pain.
This problem can respond well to anti-inflammatory drugs, cortisone injections and stretching of several gluteal muscles if treated early enough. Because of the many muscles that attach to this area, the patients dealing with this problem need to identify many different positions to stretch in. One position alone only stretches one section of one of these muscles and does not adequately affect the many areas that need to be addressed.
Although this short description of ITB syndrome addresses many components of the problem, it by no means is an inclusive addressing of the topic. ITB syndrome is a very complex problem with potential implications at the hips, buttocks, knees, feet and even the patellofemoral joints.
There are many reasons why a person will struggle with this problem based on body type, biomechanical shapes at many joints and bones and tightness of soft tissues. Not addressing ITB band problems properly and early enough can result in a tremendously difficult path of resolution.