IT band - what is it?

Iliotibial band syndrome (ITBS) is the most common cause of pain on the outside of the knee in runners, with an incidence as high as 12% of all running-related overuse injuries. Although it is not difficult to diagnose, it can be a challenge to treat, especially in higher mileage runners who place enormous loads on their bodies.

The IT band is not a muscle. It is a thick band of tissue called fascia that starts on the outside of the hip, passes down the outside of the thigh and inserts into the side of the knee cap and the shin bone. As the knee bends, tension acting on the band, causes it to be pulled backwards over the bony prominence of the thigh bone on the outside of the knee.

Why it hurts:

When the knee straightens, tension on the band pulls it forward again. A thin bursa, or fluid filled sac, separates the ITB from the femoral epicondyle, to decrease friction between these structures. Repetitive bending and straightening of the knee can cause inflammation of the bursa and the band itself, or irritation of the bone due to recurrent rubbing or impingement.

What causes it:

A number of factors have been related to ITBS in runners, but it is important to understand the cause is probably multifactorial. Weekly mileage will interact with a combination of biomechanical issues, training strategies, as well as variables imposed by an individual’s specific muscle imbalances; once critical threshold is met, tissue breakdown will occur. It is not necessary to sustain a specific traumatic injury to the knee for the ITB to become a problem.

SYMPTOMS:

- Pain from the ITB is easily recognized as a sharp or burning pain on the outside of the knee when running. Typically, an athlete is unable to “run through” ITB pain.

• Early on, symptoms will subside shortly after the run is over, but will return with the next run, usually after a reproducible amount of time.

• Later, if there has been no positive intervention, the pain may come on sooner and persist with walking or going up and down stairs.

• Tenderness may be felt on the outside of the knee when pressure is applied, especially when the knee is slightly bent.

• There is not usually any swelling associated with this problem, but the band itself may be thickened.

Dr. Dave stressed that this is not something you want to try and run through, like some soreness when training. Very common in group runs, runners will want to push through the pain, stay with the group and finish the run. You could end up having a more permanent injury doing that.