Iliotibial band syndrome

Introduction

The iliotibial band is a thick band of connective tissue that runs from the outside of the hip to the outside of the knee and down to the top of your shinbone. It helps to keep the knee stable. The iliotibial band can become inflamed in runners, cyclists, and other athletes who bend and straighten their knee a lot, causing pain in the outer part of the knee. This is iliotibial band syndrome. It is the most common cause of pain in the outer part of the knee in runners.

If you have iliotibial band syndrome, you will likely have pain on the outside of the knee.

If your doctor has told you that you have iliotibial band syndrome, you can help to reduce the pain and inflammation at home using self-care techniques such as rest, ice, and painkillers.

Your doctor may refer you to a physiotherapist who can recommend exercises to improve the strength and flexibility of your leg muscles. This can help you to manage your symptoms in the long term.

Symptoms

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The main symptom of iliotibial band syndrome is a sharp or burning pain in the outer part of the knee. The pain may move up or down the leg.

In the early stages of iliotibial band syndrome, you may only get knee pain when you are playing sports, such as running or cycling. The pain may get worse with certain activities, such as running downhill, outdoor running, or if you run for longer than normal. You may also notice that the pain tends to appear after you have run a specific distance, and it goes away when you stop.

As the condition progresses, the pain can become constant and appear when you are simply walking. Some people may find the pain is present even when they are sitting with their knee bent.

Less commonly, you may find that the pain continues for hours or days after exercise.

Your knee may also swell up and be tender to touch if you have iliotibial band syndrome.

Causes

Iliotibial band syndrome is an overuse injury that is triggered by bending and straightening your knee repeatedly. The exact cause of the condition is not clear; but it has generally not been reported by people who do not exercise.

Iliotibial band syndrome is most commonly seen in athletes, including:

  • runners
  • cyclists
  • competitive rowers
  • swimmers
  • dancers
  • people in the military

Iliotibial band syndrome is thought to be a common cause of outer knee pain. Studies have shown that the condition can affect up to 12% of runners and up to 25% of physically active people.

Your risk of developing iliotibial band syndrome can be increased by two things:

  • certain physical factors in your body
  • how you train or exercise

In most cases of iliotibial band syndrome, both the physical factors in your body and how you train contribute to the injury.

Physical factors

The physical factors that increase a person’s risk of iliotibial band syndrome are not fully understood. However, having a tight iliotibial band or weak hip muscles are thought to play a role.

Training methods

Specific training habits may also increase your risk of iliotibial band syndrome. These include:

  • interval training, hill training, and running downhill
  • excessive running in the same direction on a track
  • a sudden increase in how long you run or cycle
  • running many miles each week
  • cycling with an incorrect pedal position or a badly fitting bicycle
  • running shoes that have a heel or are too wide
  • running on uneven surfaces or in cold weather
  • taking very long strides when running

Diagnosis

Your doctor may suspect you have iliotibial band syndrome based on your symptoms, medical history, and an examination of your hip and knee.

In most cases, you will not need any imaging tests to diagnose iliotibial band syndrome, but your doctor may recommend an MRI or ultrasound scan if the cause of your symptoms is unclear.

Treatment

There is a lack of good research into the best way to treat iliotibial band syndrome. However, commonly used strategies include self-care, steroid injections, and physiotherapy.

If you think you may have iliotibial band syndrome, see you doctor. They will be able to advise you on the best treatment for your symptoms.

Self-care

Iliotibial band syndrome treatment usually begins with self-care techniques at home to reduce knee pain and inflammation. These include:

  • rest – avoid physical activities that involve repeatedly bending and straightening your knee or that trigger the pain. If your symptoms are mild, it may be ok to cut down on exercise rather than stopping it completely. Speak with your doctor to find out which exercises are safe for you to do
  • ice – apply ice to your knee for 15-20 minutes every two to three hours. Wrap the ice in a damp towel or use a bag of frozen peas. Do not place the ice directly onto your skin because it could cause a cold burn
  • painkillers – non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help relieve pain and inflammation

Some guidelines suggest you should avoid taking NSAIDs for the first 48 hours after an injury and that you should only take them for a short time period. This is because it is thought that NSAIDs may slow down the healing process. However, this is a theory that needs further research. At present, there is no conclusive evidence that proves that NSAIDs should not be taken soon after an injury.

Check with your doctor, nurse, or pharmacist if non-prescription painkillers are not improving the pain. Your doctor may be able to prescribe stronger NSAIDs or painkillers if you have a serious injury. It may not be safe to take NSAIDs if you have certain conditions (such as asthma, high blood pressure, kidney failure, indigestion or heart failure) or if you are allergic to NSAIDS. Always check with your doctor or pharmacist before taking new medicines after an injury.

Steroid and local anaesthetic injections

If your symptoms do not improve with rest, ice, and painkillers, your doctor may recommend an injection of a steroid and numbing medicine (anaesthetic) directly into your knee. This can help to relieve pain and any underlying inflammation.

Physiotherapy

If you have iliotibial band syndrome, your doctor will most likely refer you to a physiotherapist. They can help you improve the strength and flexibility of your leg muscles, to help you manage your symptoms in the long term. Physiotherapy may involve:

  • stretching exercises
  • manual therapies
  • foam roller exercises
  • exercises for strengthening your hip muscles
  • advice on how to reduce stress on your knee when exercising

If you have any physical factors that increase your risk of iliotibial band syndrome, the physiotherapist may recommend ways to manage these.

Once you are pain-free during your daily activities, you should be able to start exercising and playing sports again. Your doctor and physiotherapist will be able to advise you on how to safely build up your activity levels.

Iliotibial band syndrome symptoms usually improve with self-care and physiotherapy. If your symptoms remain even after these treatments, your doctor may recommend surgery.

Prevention

If you are an athlete or keen sportsperson, you can reduce your risk of getting iliotibial band syndrome by avoiding training techniques that can irritate your iliotibial band. Speak to your physiotherapist for specific advice on how you can prevent iliotibial band syndrome.

General actions to avoid may include:

  • always running in the same direction
  • running as a beginner without getting training advice
  • suddenly increasing how long, how far, and how often you run
  • long-distance running
  • running downhill or on banked surfaces
  • exercising with worn out or non-running shoes

Outlook

In most cases self-care and physiotherapy effectively improve knee pain, allowing you to return to your usual sporting activities within six to eight weeks. However, iliotibial band syndrome tends to come and go over time.

To find answers to any other health questions you might have, visit our Health A-Z.

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