Lateral knee pain (pain on the outside of the knee) is a common presentation to The Injury Clinic, and is regularly seen in runners. While there can be a range of reasons for lateral knee pain to occur, ITB Syndrome is the leading cause of it and the second leading cause of all knee pain in runners.
WHAT IS ITB SYNDROME?
The Iliotibial Band (ITB) is a thick band of fascia that runs down the outside of the thigh. It originates from the tensor fasciae latae (TFL) muscle on the side of the hip and the furthest part of it attaches at the front of the tibia. The purpose of the ITB is to stabilise the hip and the knee through movement.
When the ITB becomes compressed, which can be due to various reasons, it can result in pain on the outside of the knee. It is a common injury in long distance runners, as compression of the ITB usually comes from overuse of the muscles attaching to and surrounding it. It is most often correlated with a weakness in the gluteal muscles.
Patients with ITB syndrome typically present with:
- A gradual onset of sharp lateral knee pain
- Pain that occurs during repetitive activities involving knee flexion and extension and loading through the knee, such as running or going down stairs
- There can also be signs of inflammation on the outside of the knee, such as swelling and/ or heat
- ITB syndrome is more common in males than females
ASSESSMENT:
When we suspect ITB syndrome, our Physiotherapists at The Injury Clinic will do a thorough assessment of the patient’s hip and knee. This will include assessing hip and knee range of motion and strength, evaluate the condition of the leg muscles through palpation and the Ober’s and Thomas Tests, and we may analyse the patient’s running biomechanics. The Ober’s Test assesses how the ITB reacts to stretch and compression and will evoke pain patients with ITB syndrome, while the Thomas Test shows the length of the quadriceps muscle and allows the therapist to put load through the ITB to see how it reacts.
MANAGEMENT:
The Physiotherapists here at The Injury Clinic will work with our patients to manage their pain and find the right treatment for them. To treat ITB syndrome, we need to decrease pain caused by compression of the ITB with load management, release of the muscles surrounding the ITB and increasing hip and knee strength.
In summary, ITB syndrome is the leading cause of lateral knee pain in runners, and is caused by overuse and compression over the ITB, which can be treated with load management, muscle release and strengthening with the help of a physiotherapist.
Further Reading:
- Noehren, B., Schmitz, A., Hempel, R., Westlake, C., & Black, W. (2014). Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. journal of orthopaedic & sports physical therapy, 44(3), 217-222.
- McMahon, M., & Beeton, K. (2021). Iliotibial band syndrome: A survey of current UK physiotherapy practice. Physiotherapy, 113, e90-e91.
- Charles, D., & Rodgers, C. (2020). A literature review and clinical commentary on the development of Iliotibial Band Syndrome in runners. International journal of sports physical therapy, 15(3), 460.
