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Iliotibial Band Friction Syndrome

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This is a very common condition most often afflicting new cyclists or runners, and it often presents as a stinging pain at the side or length of the affected knee and hip.

The Iliotibial Band Syndrome (ITBS), also known as Iliotibial Band Friction Syndrome (ITBFS), is a very common thigh injury that is commonly known to runners, cyclists and hikers. It gets is name from the Iliotibial Band (refer picture inset) rubbing in friction against a bony protusion at the side of your knee or at your hip. You see, the ITB is a band that continues from our largest hip muscles and it’s a really thick band of fibrous tissue just outside at the side of our thighs. The muscle originates from the pelvis, and extends over the side of the hip and inserts below the knee.

Just before it inserts into the knee, it runs over a bony protusion in the thigh bone (which is the lateral femoral epicondyle). The repeated friction of this band over this bony protusion caused by repeated bending and straightening of the knee (think runners, cyclists and hikers) causes internal “friction burn” and irritates the band, and this causes inflammation. The more tight and taut our ITBs are, the harder it rubs over the protusion and the higher the friction and inflammation rate…and the more painful, of course.

Not only runners, cyclists and hikers get this. It is also commonly develops in people who suddenly increases their level of activity without gradual increase, such as people who suddenly pick up a sport or start running. Risk factors includes abnormal walking patterns such as overpronation of the feet (where the feet goes inwards because of collapsed arch or habit), leg length discrepancies or bow-legged syndrome. The most vulnerable range of knee flexion that starts and perpetuates this condition is when the knees are flexed at 30 – 40 degrees – this is where the ITB crosses (frictionally) over the lateral femoral condyle.

 What causes tightening of the Iliotibial Band?

Fundamentally, there are a total of THREE (3) things that causes tightness to the ITB, and they are: 

  1. Improper training/training methods
  2. Improper walking patterns
  3. Weakness of the outer thigh muscles 

Improper Training/Training Methods 

When runners or hikers participate in improper training, such as too fast an increase of intensity (sudden spike in speed or distance training without a gradual training plan); or training over inappropriate surfaces such as banked surfaces or commonly seen downhill running – all these increases strain over the ITB. Cyclists who tend to point their toes inwards instead of neutral forwards-facing pulls the ITB to more length, causing it to work harder along the extended length, naturally tightening the ITB.

Improper Walking Patterns

Foot structures that are/have arches that are too high or low as well as having leg length discrepancies (this means that there is uneven leg length) almost always causes the ITB to tighten on one side, because one side is worked harder than the other, causing compensation and overworking. In this, physiotherapy biomechanical assessment on your walking pattern will identify and pinpoint the problem and we can work on muscles and joints; where it is appropriate, supporting foot orthotics such as insoles may help to correct or minimise these problems.

Weakness Of The Outer Hip Muscles

Weakness of our outer hip muscles tends to cause our iliotibial band to overwork to compensate for it. This causes our ITB to become tight and gradually becoming an Iliotibial Band Friction Syndrome. A combination of deep tissue massage/release to loosen ITBs, stretching and strengthening the weak outer hip muscles will help to diffuse the load across and ensure that our ITB don’t overwork.

Summary

Well, even though one may have cautiously managed and avoided all the three abovementioned points, still, athletes who clocks high training hours, volume and intensity almost always have painful ITBs because of their high intensity training. In such situations, regular deep tissue release and massage with our sports massage/deep tissue release therapist will help to release the tight band (see who your therapist will be), and keep it at optimal length for best sports and training performance.

Please don’t forget to stretch your ITB after every session of exercise and training or games. Too much and too long of ITB tightness can even lead to pain in the deep muscles of your groin and even to low back pain because it may alter the way you move and cause improper walking.

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