Running Injury Series: Iliotibial Band Syndrome

Pain on the side of the knee is a problem experienced by many runners. The iliotibial band is a band of fascia that extends from the gluteal area to just below the outside of the knee. The tensor fascia lata and the gluteal muscles blend together to make the muscular portion of the iliotibial band. When these muscles are tight, there will be increased tension on the iliotibial band. 

What are the Symptoms  

Iliotibial band syndrome symptoms include pain on the outside of the knee that is worse with bending to about 30 degrees. The pain is typically made worse with repetitive bending of the knee (running) and relieved with rest. 

What Causes Iliotibial Band Syndrome

Iliotibial band syndrome is an overuse syndrome. Previously, it was thought that the iliotibial band would rub over a bony prominence at the side of the knee. Newer research suggests that it is actually compression of the iliotibial band on the outside of the knee that causes pain, not friction. 

Iliotibial band syndrome is common in runners because of poor core and pelvis stability.  If you cannot stabilize your core and pelvis, your gluteal muscles will go into spasm to provide stability. The increased tension on the iliotibial band causes compression and irritation at the side of the knee, leading to the development of pain. 

Preventing Iliotibial Band Syndrome 

Altering your mileage is an important aspect of preventing iliotibial band syndrome. Once your stabilizer muscles fatigue, your body will compensate to provide stability. By decreasing a combination of your running distance, frequency, or duration, you can reduce the risk of injury. If you are in pain, typically reducing your running by 50 percent will alleviate the pain. 

Self-myofascial release to the gluteal region will help decease the tension on the band. Typically we do not recommend rolling on the iliotibial band because it does not contract. To foam roll the gluteals, sit on the foam roller at about a 45 degree angle. Whichever side you are sitting on, cross that leg over the other leg. Roll on the gluteal area for 20-30 seconds. 

Strengthening the stabilizers of the hip will help decrease the spasm of the muscles. Penguin walks are a great exercise to increase endurance. Take a mini-loop and place it around your knees. With your toes pointed straightforward, side step while maintaining a neutral spine (no leaning!). Go for 10 feet and then go back facing the same direction. 

Getting Treatment for Iliotibial Band Syndrome 

Iliotibial band syndrome typically responds well to conservative therapy. Chiropractic adjustments aid in reducing the tension in the pelvic muscles and restoring proper mechanics to the lumbo-pelvic-hip complex. 

Manual therapy is also a great supplement to decrease the tension in the gluteals and other involved muscles, which decreases the tension on the iliotibial band. 

Finally, corrective exercises should be added to restore proper biomechanics. Building endurance of the core and hip stabilizers should be the focus of a corrective exercise program. 

As a last resort, surgery may be an option for cases that do not resolve. Most cases do not require surgical intervention to release the iliotibial band. It is recommended to have a trial of conservative treatment before seeking surgery. 

In conclusion, running is a great form of exercise, but it requires some general maintenance. Because of the repetitive nature of running, if you don’t do some cross training and mobility training, you put yourself at risk of repetitive stress injuries. Creating a program that includes some non-sagittal plane exercises and mobility drills can help you stay running longer. If nothing you are doing is helping, don’t be afraid to seek help!