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Training & advice

Simon Moyes' top tips on how to treat Illotibial Band Syndrome

Simon Moyes discusses yet another injury which can seriously hamper runners.

Iliotibial Band Syndrome (ITBS) is a common thigh injury and one of the most common lateral knee conditions that affect runners. The condition, which is appropriately also known as runner's knee, also affects cyclists, hikers and weightlifters.

The Iliotibial band is a thick, fibrous connective tissue on the outside of the thigh and runs from the hip to the outer side of the shin bone (tibia) just below the knee joint. Its primary function is helping the knee joint to extend in addition to abducting the hip, providing stability in the knee.

ITBS typically occurs when the iliotibial band becomes inflamed, which is usually caused by irritation to the fibrous tissue. This irritation usually develops over the outside of the knee joint at the end of the femur. This prevents the iliotibial band from crossing the bone and muscle at this point smoothly and consequently restricts movement and causes the sufferer intense pain.

The injury can also develop in people who decide to suddenly increase their level of physical activity. For example, runners who increase the number of miles they run over a very short period of time will be prone to ITBS. It can also affect people with mechanical problems with their gait such as those with leg length discrepancies or who those who are prone to overpronate.

Patients who develop ITBS will typically feel a sharp pain or stinging sensation around the outside of the knee, just above the knee joint in addition to tightness in the iliotibial band. Whilst pain may not instantly develop during physical activity, it is likely to heighten over time and exaggerate the injury further. Patients may also experience weakness in hip abduction.

The Iliotibial ban often becomes inflamed due to unusual rotation which originates either from excessive pronation or poor hip control so initially, to reduce pain and inflammation, the R.I.C.E (Rest, Ice, Compression, Elevate) method of treatment will be used. This should then be followed by regular stretching of the injured joints. In some cases, your doctor may prescribe anti-inflammatory medications to aid the process of healing and reduce inflammation.

However, if patients have not responded to these forms of treatment, within two weeks, they will be required to work with a physical therapist to develop a programme.

Initially a physical assessment will be carried out by the therapist who will perform two main tests.

During the first test - Palpation of the iliotibial band - the therapist will feel up and down the full length of the iliotibial band to look for tender areas around the knee and to feel where the tension and tight spots along the IT band are. The second is the Obers test, which is designed to assess the general tightness of the IT band.

Treatment will start by reducing the level of pain felt by the patient. This will include resting, physical therapy and cross training to maintain fitness without aggravating the injury. This will be followed by regular physiotherapy designed to reduce pain and build up strength in the thigh and gluteal muscles. This can be achieved through step lunges and leg squats.

In addition to physiotherapy, it is also advised that patients visit a musculoskeletal podiatrist, who specialise in the treatment of biochanical conditions which primarily affect the lower limbs. Gait analysis is one of several invaluable tools that Musculoskeletal Podiatrist's can use to assist in their diagnosis of chronic lower limb injuries which is particularly useful when dealing with sports injuries. Musculoskeletal Podiatry is the assessment, diagnosis and treatment of biomechanical conditions which primarily affect the lower limbs.

Typically patients will start to return to their normal level of fitness within two weeks of starting treatment. After the initial pain has subsided and a regular stretching routine has been established, patients will then be able to focus on strengthening the surround structures. This will include immobilizing the damaged tissues and strengthening the hip and thigh muscles and achieved through a more comprehensive stretching programme.

At the end of this process, most patients will show strong signs of recovery however, if treatment has been unsuccessful surgery will be considered; although this only happens in very rare circumstances.