Education

Tips to Reduce the Risk of Iliotibial Band Syndrome

by Jason Brumitt, MSPT, SCS, ATC/R, CSCS,*D

Includes background on the IT band syndrome and exercises that can be used to reduce its risk of injury. From the NSCA's Performance Training Journal.

Iliotibial Band Syndrome (ITBS) is an overuse injury experienced primarily by distance runners but may be experienced by a wide variety of individuals and other athletes (e.g., cyclists, hikers). The primary symptom associated with ITBS is lateral knee pain. Initial symptoms may be minor, with one experiencing pain at some point during their physical activity.
As the condition worsens, pain may prevent the individual from training and may even be present when at rest.  Assessing one’s risk factors may help reduce their risk of experiencing this type of injury.

What is ITBS?

The iliotibial band (ITB) is a tendon-like structure (a thickening of fascia) that extends from the thigh’s tensor fascia latae muscle and extends distally to attach to the lateral (outside) portions of the knee and tibia.
Recent studies suggest that nerve innervated soft tissue is compressed between the ITB and the lateral (outside) portion of the femur (2). Instead of an anterior-posterior slide creating friction leading to ITBS (also called Iliotibial Band Friction Syndrome based on this assumption), recent studies propose that pain is due to the compression of the fat and soft tissue between the ITB and the femur (2).

What Can Be Done to Reduce Injury Risk?

ITBS may be caused by extrinsic and/or intrinsic risk factors. Extrinsic factors that may contribute to the onset of ITBS include poor or worn-out footwear, increasing training distances too quickly, running too many miles in general, and downhill running (1,3,4). Intrinsic risk factors for ITBS include poor mechanics when running, weakness in the hip abductors, muscular imbalance around the hips, and muscular tightness in the legs (3,5,6).
Distance runners may benefit from a having a coach or sports medicine professional perform a running evaluation. Video analysis of one’s running technique may highlight faulty mechanics.  In addition, distance runners should purchase new running shoes frequently, generally after 300 to 500 miles of use. With a wide array of shoes on the market it is helpful to seek recommendations from a podiatrist, sports medicine professional, or from a specialty shoe store.

Exercise

Simple exercises requiring minimal equipment may help improve strength about the hips and reduce the risk of developing ITBS. The hip abductors (especially gluteus medius) have often been identified as dysfunctional in individuals diagnosed with ITBS (3). The gluteus medius muscle helps to maintain stability of the pelvis when running. Weakness in the hip abductors will allow increased hip adduction and knee internal rotation, factors that may contribute to the onset of ITBS (5).
The side lying straight-leg raise exercise will effectively train the gluteus medius muscle. To perform this exercise one will lie on their side and raise the top leg in a controlled movement, focusing on keeping the leg straight.
When performing the exercise, make sure that one feels muscular activation in the posterior-lateral hip versus the front of the hip. If performed incorrectly, one will often feel muscle activation of the anteriorly positioned tensor fascia latae or hip flexor muscles. In addition, when performed incorrectly, the leg will deviate anteriorly during the lifting motion. Perform two sets of 15 repetitions of this exercise two to three days a week to improve strength of the gluteus medius.
In addition in the side lying straight-leg raise exercise, one may benefit from performing an ITB stretch. In a standing position, cross one leg behind the other extending the arms overhead with the fingers interlocked. To perform the stretch, lean to the side opposite of the rear leg (i.e., if the right leg is crossed behind the left, the upper extremities should lean toward the left) (3).  Perform two to three repetitions of this stretch (holding each stretch for 30 seconds).
This stretch can be performed before or after physical activity.
By utilizing both the side lying straight-leg raise exercise and the ITB stretch, one can help prevent the occurrence of ITBS and reduce the risk of potential injuries.

References

1. Beals, RK. The iliotibial tract: A review. Curr Orthop Pract 20(1): 87–91, 2009. 
2. Fairclough, J, Hayashi, K, Toumi, H, Lyons, K, Bydder, G, Phillips, N, Best, TM, and Benjamin, M.  The functional anatomy of the iliotibial band during flexion and extension of the knee: Implications for understanding iliotibial band syndrome. J Anat. 208: 309–316, 2006. 
3. Fredericson, M, and Wolf, C. Iliotibial band syndrome in runners: Innovations in treatment. Sports Med 35(5): 451–459, 2005. 
4. Messier, SP, Legault, C, Schoenlank, CR, Newman, JJ, Martin, DF, and Devita, P. Risk factors and mechanisms of knee injury in runners. Med Sci Sports Exerc 40(11): 1873–1879, 2008.   
5. Noehren, B, Davis, I, and Hamill, J. Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech 22: 951–956, 2007. 
6. Strakowski, JA, and Jamil, T. Management of common running injuries. Phys Med Rehabil Clin N Am 17: 537–552, 2006. 

This article is from NSCA's Performance Training Journal 10.3. Gain access to more journal articles with an NSCA Membership.

About the Author

Jason Brumitt is an assistant professor of physical therapy at Pacific University (Oregon). He is currently a doctoral candidate with Rocky Mountain University of Health Professions.