The iliotibial band is a thick fibrous sheath that runs along the outside of the thigh. It can rather easily get inflamed. If you’re a runner, you may have experienced an iliotibial band injury. It’s one of the most common causes of lateral (outer) knee pain. In the most severe cases, the pain can be excruciating and require several weeks of recovery.
Before you can prevent or treat an ITB injury, you must know what’s causing it. Here is a rundown of some of the most common causes and ways to avoid an ITB injury. A diagnosis by a trained medical professional is best, especially if the pain is severe.
Cause: Tightness of the tensor fascia lata (TFL) and gluteus medius and maximus.
Treatment: Stretch the muscles to improve flexibility. If tightness in the hip flexors limits the effectiveness of the stretch, address this as well. Figure A demonstrates the stretch found most effective. The stretches shown in Figures B and C provide a stretch to the TFL, but they have proved less effective . In the pictures, note that the right leg is the involved leg.
ITB Stretch, Figure A
ITB Stretch, Figure B
ITB Stretch, Figure C
Stretches alone may not be enough. Self-massage techniques are also beneficial. Rolling the affected leg on a foam roller as shows in Figure D can help elongate the tissue and relieve stress at the outside of the knee.
Foam Rolling, Figure D
Cause: Weak hip abductors.
Treatment: Developing the muscles on the outside of the hip will prevent or reduce ITB-related pain. It is important to perform these exercises with proper form. Keep your toes pointed forward to reduce compensation by rotating your leg outward. This exercise can either be performed lying on your side (Figures E and F) or while standing (Figures G and H). When doing the exercise on your side, the leg performing the motion is the involved leg. While standing, the motion occurs at the uninvolved leg, and the muscles of the involved leg work to stabilize the pelvis.
Strengthening the Hip Abductors, Figure E
Strengthening the Hip Abductors, Figure F
Strengthening the Hip Abductors, Figure G
Strengthening the Hip Abductors, Figure H
Cause: Over-pronation of the foot. When the foot pronates, the tibia rotates inward. The ITB attaches to the tibia, so this rotation can cause shear force at the ITB and friction and/or compression where the ITband crosses the knee joint.
Treatment: This may be reduced by selecting proper footwear or using orthotics to correct the pronation.
Cause: Improper training. Some training errors are: increasing hill workouts or speed workouts too dramatically; excessive running on created surfaces in the same direction; and increasing mileage too rapidly. Lots of downhill running and over-striding may also contribute to the development of ITB-related pain.
Treatment: Scale back on these training practices.