Treatment and Prevention of Iliotibial Band Syndrome
Knee pain and injuries, as a result of iliotibial band (ITB) syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints.
Knee injuries are very common among runners and cyclists. However, they doesn’t usually occur in an instant, like a hamstring strain or groin pull. It commonly starts off as a “twinge or niggle” and progress quickly to a debilitating sports injury that can sideline the best of us for weeks.
For those who aren’t familiar with ITB syndrome, let’s start by having a look at the muscle responsible for the problem. The iliotibial band is actually a thick tendon-like portion of another muscle called the tensor fasciae latae (TFL). This band passes down the outside of the thigh and inserts just below the knee.
The diagram to the right shows the side (lateral) and front (anterior) view of the thigh muscles. If you look towards the top of the diagram, you’ll see the TFL muscle. Follow the tendon of this muscle down and you’ll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band.
The main problem occurs when the TFL muscle and ITB become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.
There are two main causes of knee pain associated with iliotibial band syndrome. The first is overload and the second is biomechanical errors.
Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner’s injury. When the TFL muscle and ITB become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.
Overload on the ITB can be caused by a number of things. They include:
Exercising on hard surfaces, like concrete;
Exercising on uneven ground;
Beginning an exercise program after a long lay-off period;
Increasing exercise intensity or duration too quickly;
Exercising in worn out or ill fitting shoes; and
Excessive uphill or downhill running.
Biomechanical errors include:
Leg length differences;
Tight, stiff muscles in the leg;
Foot structure problems such as flat feet (pes planus); and
Gait, or running style problems such as pronation.
First and foremost, one should have a full examination of their gait and posture to identify any postural misalignments as this may help reveal the underlying cause. This service is offered by both of the Chiropractors in the clinic- Drs. Serné and Tisshaw. They will then provide a treatment plan to correct for any biomechanical faults.
The basic treatment for knee pain that results from ITB Syndrome is no different to most other soft tissue injuries. Immediately following the onset of any knee pain, the R.I.C.E. regime should be applied. This involves Rest, Ice, Compression, and Elevation. It is critical that the R.I.C.E. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
Ongoing Treatment and Prevention
Although the pain may be felt mainly in the knee, the problem may actually be caused by the muscles that support the knee; the tensor fasciae latae, quadriceps, hamstrings, and the gluteus muscles.
After the initial examination, implementation of a program to include electrical therapy, deep tissue massage, and chiropractic adjustments should be followed. It may be just what you need to help loosen up those tight muscles and restore fluid mechanical movement.
Firstly, don’t forget a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the leg muscles, which will result in a lack of oxygen and nutrients for those muscles.
Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
Secondly, flexible muscles are extremely important in the prevention of most leg injuries. When the muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.
The stretch to the right is one of the best stretches for the tensor fasciae latae.
Stand upright and cross one foot behind the other. Then lean towards the foot that is behind the other. Hold this stretch for about 45 seconds, and then repeat it 3 to 4 times on each leg.
Stretching is one of the most under utilized techniques for improving athletic performance, preventing sports injury, and properly rehabilitating sprain and strain injury. Please don’t make the mistake of thinking that something as simple as stretching won’t be effective.
And thirdly, strengthening and conditioning the muscles around your knee and upper leg will help greatly to reduce the chance of knee injury and knee pain.
Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic