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Iliotibial Band Syndrome

Iliotibial Band Syndrome: Dispelling Myths and Optimising Treatment Strategies

 

Iliotibial Band (ITB) syndrome is a prevalent overuse injury among runners, characterised by lateral knee pain. This article aims to provide a contemporary understanding of ITB syndrome pathogenesis and debunk some commonly held misconceptions regarding its aetiology and management.

 

The ITB: A Dynamic Stabiliser

 

Unlike most tendons, the ITB is a structure unique to humans. It develops during infancy as we transition to bipedal gait. The ITB stretches from the iliac crest to the lateral aspect of the knee, serving two critical functions:

 

  1. Energy Storage and Release: The ITB functions like a spring, storing and releasing elastic energy during running, contributing to increase running economy
  2. Joint Stability: The ITB provides crucial stability to the knee joint, preventing excessive valgus movement and guarding against external forces encountered during running.

 

 

Rethinking the Mechanism of ITB Syndrome

 

Traditionally, ITB syndrome was attributed to frictional irritation between the ITB and the lateral femoral condyle. However, recent anatomical research suggests this mechanism is unlikely due to the fascial tethering of the ITB to the femur.

 

A more plausible explanation centres around a compressive mechanism. ITB syndrome likely arises from compression of the richly innervated adipose tissue located deep to the ITB as the knee flexes and extends. This repetitive compression during running leads to inflammation and pain.

 

 

Risk Factors and Considerations

 

Knee injuries constitute nearly 50% of all running-related injuries, with ITB syndrome being a significant contributor. Interestingly, there appears to be a gender bias:

  • Males: Exhibit a higher prevalence of ITB syndrome (50-81%) compared to females (16-50%). Males are also more likely to experience patellofemoral pain syndrome (PFPS)
  • Females: have a higher incidence of PFPS (62%) compared to ITB syndrome

 

Several factors influence the risk of developing ITB syndrome:

  • Rapid Training Increases: Novice runners who abruptly increase training volume or intensity are particularly susceptible
  • Downhill Running and Uneven Surfaces: These activities impose greater stress on the ITB
  • Running Biomechanics: Certain running styles may predispose individuals to ITB syndrome

 

 

Debunking Common Myths and Addressing the Root Cause

 

It is important to dispel some widely held misconceptions regarding ITB syndrome:

  • Stretching the ITB or addressing leg length discrepancies, gluteal weakness, or foot pronation are unlikely to prevent ITB syndrome
  • While gluteal weakness may be observed in individuals with ITB syndrome, it is more likely a consequence of pain-induced gait adaptations, rather than a causative factor.

 

 

Therefore, while gluteal strengthening is essential for overall running health, it likely has minimal impact on preventing ITB syndrome itself.

 

 

Effective Strategies for Managing ITB Syndrome

 

Here are some evidence-based recommendations to optimise ITB syndrome management:

  • Gradual Training Progression: Implement a structured training plan that gradually increases distance and intensity to allow for appropriate musculoskeletal adaptation. Look to add volume before intensity and when intensity is added, temporarily reduce volume
  • Surface Selection: Favour flat or mildly uphill terrains, especially during initial training phases.
  • Strength Training Focus: Prioritise strengthening the hips and core to enhance overall stability and running mechanics.
  • Professional Guidance: Consult your osteopath for a comprehensive assessment of your running form. They can design a personalised exercise program to address any biomechanical deficits contributing to ITB syndrome and recommend therapeutic interventions to manage pain and prevent future occurrences.

 

 

By understanding the current understanding of ITB syndrome aetiology and implementing these preventative measures, runners can effectively manage this condition and keep their training on track.