Physio Treatment for Knee Pain from Ilio Tibial Band Syndrome

Nick, in Sheffield, England asks:

"I am a keen runner and have recently completed a couple of marathons. During the training for the last one I noticed a pain over the outside of my left knee which the doctor has said is Ilio Tibial Band Friction Syndrome. He has advised me to rest. What is the physio treatment for this?"

Marc R. Bernier, Senior Physical Therapist responds:

"The Ilio-Tibial Band (IT Band) is a thick fascial structure that extends down the lateral aspect of (furthest from the mid-line of the body) the leg from the hip to the knee. The distal aspect of the IT Band is often a site of irritation in athletes involved in repetitive flexion-extension movements of the knee, such as in running and cycling.

"Initially, the acute symptoms of the condition must be treated to decrease the patient's pain and inflammation. This is typically accomplished via modalities such as ice, heat, ultrasound, electric stimulation and gentle massage for inflammation.

"As the acute symptoms subside, further evaluation and treatment is required to establish the underlying reasons for the cause of this condition. There are many potential contributing factors, and more than one may be present. Therefore, it is highly recommended that anyone with this syndrome seek the treatment of a physical therapist, so that a thorough evaluation can be performed and the appropriate treatment can be prescribed. If the underlying causes are not addressed, the symptoms are likely to reappear.

"In my experience, patients with this condition usually fall under one (or more) of the following clinical presentations: :

Biomechanical abnormalities of the foot/Improper footwear
Gluteus Medius weakness
Iliotibial Band tightness

Biomechanical abnormalities of the foot/Improper footwear

"From a biomechanical perspective, the knee is highly influenced by the foot. Hyperpronation of the foot (excessive inward rolling of the foot during running) will cause a resultant increase in Tibial internal rotation (the shin bone rotating inwards), which can place excessive stress on the IT Band. This stress can result in soft tissue inflammation and subsequent pain. Treatment can include the prescription of an 'orthosis' (special insole which supports the foot and prevents too much inward rolling of the foot) and proper footwear prescription to ensure that the athlete is using shoes appropriate for his/her foot type and activity.

Gluteus Medius weakness

"The knee is also highly influenced by biomechanical abnormalities or muscular weakness of the hip and core muscles of the trunk and pelvis. Research has indicated that weakness of the Gluteus Medius muscle was prevalent in long distance runners with this condition. This muscle is located at the top of the buttocks, and can usually be palpated just above the back hip pocket. This muscle is responsible for both abducting (raising out to the side) and externally rotating the leg. However, it's more important function is its role when the leg is in a weight-bearing position. During running, cutting and planting maneuvers it prevents the thigh from 'buckling' and rotating inwards.

"A therapy program that specifically targeted Gluteus Medius strengthening resulted in an elimination of symptoms in most cases. Strengthening of this aspect of 'the core' will better enable the patient to control the lower extremity and help prevent the thigh 'rolling in' during running.

Side Llying Abduction
Side Lying 'Clamshells'
Prone Hip External Rotation
Single Leg Bridging
'Donkey Kicks'
Standing Abduction with Surgical Tubing

Iliotibial Band tightness

"The ability to truly 'stretch' the IT Band is a source of significant controversy. Many therapists have prescribed 'IT Band stretches' as a part of the therapy regiment. However, it must be understood that the IT Band is not a muscle, but a very thick piece of fascia that cannot be stretched, especially at the lower part, around the knee joint.

"The stretches that have been used will actually stretch the Tensor Fascia Latae (TFL) muscle in the hip. While this may result in a slight increase in IT Band length indirectly due to it's attachment to the TFL, it will not address the fascial tightness that is present at the lower part of the IT Band. The treatment for this situation consists of extensive soft tissue mobilization and massage to the lower part of the IT Band, and fascial stretching using foam rolls at home."

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Article published: 21st November 2005