Another Source of Knee Pain: Iliotibial Band Friction Syndrome

By: Brad Homan, D.O.

FA15.IliotibialBandSyndrom.11.27.11.jpgKnee pain is a common complaint for both active and inactive individuals. One of the most common causes of pain on the outside of the knee is iliotibial band friction syndrome (ITBFS). Although ITBFS is most commonly encountered in runners and cyclists, it can occur during any activity.

The iliotibial band (ITB) is a thick layer of tissue (called fascia) that originates at the top of the hip and extends downward over the outside of the knee. Iliotibial band friction syndrome occurs when repetitive movement causes excessive friction between the ITB and the bony prominence on the outside of the knee. This leads to inflammation which causes pain and tenderness to touch. Early in the onset of this injury the pain occurs toward at the end of a workout. As the condition progresses the symptoms begin earlier during exercise. Pain from ITBFS is worsened by increasing strides or running down hills and can eventually lead to a loss of strength.

Causes of ITBFS include poor running surfaces, poor equipment, improper positioning (as in cycling), increased mileage, and changes in training surface or intensity. Causes related to body structure include weak hip and core muscles, muscle imbalances, and lack of flexibility in the quadriceps, hamstrings and iliotibial band.

If you notice the onset of ITB pain, you can prevent the discomfort from getting worse by modifying your workout (swimming instead of running, avoiding downhill running or running on banked roads), using cold therapy, stretching, and taking anti-inflammatory medication (NSAIDS) such as ibuprofen or naproxen. If symptoms persist or worsen you should consider having your injury evaluated by a physician. You may benefit from a formal physical therapy program for treatments and appropriate stretching/strengthening to resolve the injury and prevent this condition from recurring.

Full restoration of pain free activity may take several weeks. Once all stretching and strengthening exercises can be performed without pain, training sessions of choice (running, biking, dancing) can resume. Return to activity should be gradual to prevent return of symptoms and get you back to sport.