ITB injuries Article

 

Hi all and welcome to my first article. I’ll be sending out articles every couple of months on various topics related to running and I hope you find them helpful. Today I want to talk about iliotibial pain (lateral knee pain). After increasing my training load on my return from London I suffered with iliotibial pain for a couple of months. It can be a very frustrating injury to rehab, you finally think you’ve hit it on the head and then it reappears out of nowhere! So I wanted to give you some information about it and I’ll be posting videos of some useful exercsies on my facebook page so keep an eye out.

Iliotibial band (ITB) injuries are the second most common knee injury seen in runners (secondary to patellofemoral/knee cap pain). Symptoms of ITB present as pain across the lateral or outside aspect of the knee during running and will often get worse as you continue through the run or when going up and down hills. There are often a multitude of factors that can contribute to ITB pain which is why it can be a very difficult injury to treat. Overtraining/rapid increases in training loads can significantly increase your risk of attaining an ITB injury.

Anatomy of the ITB

The ITB has proximal attachments to the tensor fascia lata (TFL), gluteus maximus, and gluteus medius muscles. It then runs down the length of the femur (thigh bone) and inserts just below the outside of the knee. It also has some attachments around the patella, lateral hamstrings and quadriceps. Recent studies have suggested that when the ITB becomes tight it compresses on an underlying fat pad which causes inflammation and pain.

Function of the ITB

The main function of the ITB is to assist the hip muscles in stabilising the pelvis. In single leg stance the hip abductors (gluteus medius and gluteus minimus) should produce around 70% of the force to stabilise the pelvis whilst the ITB/TFL/outer quadriceps and upper gluteus maximus produce the remaining 30%. If the hip abductors are not working sufficiently to stabilise the pelvis then you will often get an increased contribution of the ITB or alternatively you could get an increase in hip adduction (knee moving inwards) which can cause inflammation around the insertion point of the ITB. Poor running technique may also contribute to the pain.

KEY CONTRIBUTING FACTORS

Weakness of gluteus medius/minimus
Rapid increase in training loads
Running technique errors

  • Increased hip adduction or knee internal rotation (knee turning in)
  • Increased foot pronation (arch dropping/foot turning in)
  • Narrow step width or cross over gait
  • Increased knee bend when the foot contacts the ground

ASSESSMENT

A full assessment of the strength, control and flexibility of the lower limb will help to determine potential contributing factors
A thorough assessment of running technique needs to be completed to address technique errors

TREATMENT

Load management!
Gluteus medius strengthening/activation exercises
The benefits of rolling out the ITB are debatable however releasing the surrounding muscles such as the TFL, lateral quads, lateral hamstrings and gluteals may be beneficial.

Check out my facebook page Running Physiotherapy Williamstown as I’ll be posting up videos and pictures of some great gluteus medius exercises over the next few weeks!

If you have any questions or want to know more about ITB injuries email me at

abby@runningphysiotherapy.com.au

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