Since Iliotibial Band Syndrome (ITBS) is one of the most common causes of knee pain in runners AND we are in full marathon season mode, I thought it would be timely to discuss this frequently seen diagnosis.
Multiple factors present themselves in an ITBS plagued athlete. Common causes include ramping up mileage/intensity too quickly, running on a banked surface, inefficient/poor running mechanics and/or a drastic or immediate change in running shoe style. Although your physical therapist (PT) will educate you on how to reduce these external factors, your PT will primarily focus on identifying and treating the biomechanical/internal causes of your pain. The most common causes include weakness in your core and gluteus muscles that lead to overuse of the Tensor Fasciae Latae (TFL). Since the gluteus and TFL muscles blend with the ITB near the hip, weakness in one of these muscles can lead to tightness in the ITB. This along with other soft tissue and/or joint tightness/restrictions at the hip and knee can limit flexibility and alter the alignment between the hip and knee joints, resulting in abnormal knee mechanics that cause excessive friction and strain on the lower part of the ITB where it inserts at the knee during running.
Once the specific cause of your knee pain is identified, your physical therapy treatment will be designed to correct the problem. Often treatment will start with soft tissue massage, stretching and joint mobilization to address the muscle, soft tissue and joint tightness leading to alignment issues. As joint and soft tissue mobility is improved, treatment will focus on specific exercises to address any core, hip and lower extremity weakness. Treatment will also include plyometric and balance activities to enhance neuromuscular/proprioceptive control of the leg during the push off and landing phases of running. Your PT may recommend a reduction in running miles initially but as your pain is resolved, you will likely be able to work slowly back into your training program. You will also likely be given a home exercise program that continues to focus on functional strengthening exercises, stretching and foam rolling to prevent a return of ITB tightness.
I learned what ITBS was the hard way a long time ago. As a result, I am passionate about helping fellow runners/triathletes not only pursue their passion for running but enhance their performance through prevention and effective treatment of this common syndrome.