What’s So Special About The Iliotibial Band?
The sun is out finally again as we move into running season here in Sydney and in Randwick with so many beautiful costal areas and parks right on our doorstep it really is a runners paradise here in the Eastern Suburbs. If you yourself are a keen runner then most likely you’ve heard of the ITB, perhaps you have been told it is to tight, you may have even had a situation where your ITB has contributed to symptoms potentially impacting your running…
In the following blog I will help you understand more about your ITB, what it actually is, its function and some potential situations where someone may suggest that the ITB is your problem.
So…What Is The ITB?
ITB is an abbreviation for iliotibial band, it is also sometimes referred to as the iliotibial tract. What it is, is a thick band of fascia, a strong and tough fibrous connective tissue made mostly of collagen fibers. Collagen is one of the strongest structures in body, it is relatively non-elastic, giving the ITB significant strength in the direction that the tract is running.
The facial band of your iliotibial tract originates from a couple of muscles around the hip, namely your TFL (Tensor Fascia Lata) and glut max (Gluteus Maximus). From these origins the connective tissue forms a wide band flowing down over the hip bone running along the lateral side of the thigh before crossing the knee joint on the way to its insertion just below the knee. The insertion point for the iliotibial tract is on a point known as ‘Gerdy’s Tubercle’ at the lateral condyle of the Tibia.
In short your ITB is a very strong non-elastic fibrous band running from the hip down the outside of the thigh before attaching itself just below the knee, but for most reading this that doesn’t actually tell us much about its function and why it is deemed so infamous amongst runners.
The Function Of Your ITB
The iliotibial band plays an important role in running with regard to movement and stability of the lower limb by its role in connecting the above mentioned hip muscles to the lower leg. A few reasons your ITB gets some much hype include its important role in assisting stability of the lower limb during the stance phase when running. Assisting the muscles that fight against the impact force on foot contact and the overall forces of gravity, working to keep the body upright as well as helping resist any undesirable torsional movements at the knee joint.
- The existence of the ITB allows the TFL and glute max muscles to act and support extension and stabilization of the knee.
- Again through TFL and glute max muscle origins the ITB can assist movements of the hip and thigh, namely abduction crucial for maintaining stability of the trunk running.
The Iliotibial Band At The Knee
Iliotibial Band Syndrome is a common cause of knee pain in runners and one of the most common running injuries we come across at in our Randwick physio practice. As previously mentioned the ITB can act as a stabilizer of the hip and knee and when running is placed under considerable tension as it assists the stabilisation of the lower limb. During running some individuals will experience symptoms as the iliotibial band “rubs” backwards and forwards over the lateral condyle of the femur and the underlying fat pad. This “rubbing” can occur under considerable force as the knee bends and extends throughout the running stride. With repeated “rubbing” as can happen during long distance running the area can become inflamed, causing irritation to the ITB and surrounding tissues causing discomfort felt most notably during the stance phase of the stride. Typically iliotibial band syndrome pain is experienced on the outside of the knee slightly above the joint commonly tender to palpation at a little boney prominence on the outside of the knee referred to as lateral epicondyle of the femur where the friction can occur.
Clichéd Iliotibial Band Syndrome Pain Pattern
Iliotibial band syndrome pain is usually experienced shortly after initial contact with the ground as the knee bends under load progressively worsens with repetition of this action throughout a run. With iliotibial band syndrome (ITBS) the start of a run the knee commonly feels totally fine, only for pain to develop and often build throughout the run. With the onset of pain occurring often after a relatively short period of time 1-2km into the session (obviously varying between runners depending on severity and individual circumstances). Following the onset, any pain experienced may persist unchanged, or build up to a point where the pain is uncomfortable enough to cause the individual to try to adjust their running style in an attempt to avoid loaded knee flexion, seeing them attempt to run with a somewhat straight knee or simply stop running altogether.
ITBS is commonly more impactful with long (slow) running, running downhill’s or when running down stairs. Any pain experienced running frequently persists in some way, shape or form for a day or two despite cessation of running. In such a situation of lingering pain being felt after running it is again normally most noticeable going down hills and stairs. However, for some runners suffering with ITBS walking in general is uncomfortable for a day or two post run.
ITBS And Physiotherapy
Physiotherapists regularly successfully help runners manage their ITBS, multiple approaches can be of benefit with ITB pain. Physiotherapists may suggest that treatment focuses on addressing strength around the hip and knee, mobility of the hip and knee, foot biomechanics and footwear changes, running stride and training load adjustments, but not uncommonly a combination of all those things will be relevant in many runners… Managing ITBS pain is not a one size fits all approach where some runners will benefit mostly a strengthening approach and others more from adjustments to stride length
and foot biomechanics… Our Randwick physio team are trained in identifying which approach/approaches would best help manage a successful return to pain free running pain and work closely with our podiatrists when needed to help achieve a quick return to training.