Iliotibial Band Syndrome

What is it Iliotibial Band Syndrome? 
Iliotibial band syndrome (ITBS) is an overuse knee injury that usually presents with pain on the lateral (outside) aspect of the knee, which can be tender to touch. It is a common sports injury associated with repetitive knee flexion and extension movements frequently seen in cyclists and runners. This repetitive motion causes excessive friction between the lateral femoral epicondyle and the iliotibial band.
The iliotibial band helps stabilise the lateral aspect of the knee through movement and is a thick band of dense fibrous connective tissue that the Tensor Fasciae Latae (TFL) and Gluteus Maximus muscles attach to. Despite common belief, you can’t stretch the IT band, it is meant to be tight, but you can stretch the muscles that connect to it.

What causes IT Band Syndrome? 
At around 30° of knee flexion during foot strike and the early stance phase of running, the IT band moves over the lateral femoral epicondyle. This is known as the impingement period in the running cycle, and eccentric contraction of the TFL muscle and of the Gluteus Maximus causes the leg to decelerate, generating tension in the IT band.
Sudden increases in activity levels can also lead to ITBS, as well as long distance running, particularly on a slight decline as the subtle drop of the outside of the foot stretches the IT band, increasing the risk of injury.
Muscle weakness of the hip abductors - Gluteus Medius, Gluteus Minimus, and TFL -  is also be associated with iliotibial band syndrome as this causes increased hip internal rotation and knee adduction.

Clinical Presentation/characteristics 
A common symptom of IT Band syndrome is a sharp pain on the outside of the knee, particularly during the heel strike phase of running, that can radiate into the outer thigh or calf.
The pain tends to be worse when running or coming downstairs. Sometimes with an audible snapping sensation the knee bends due to the band flicks over the bony tubercle. There may also be some swelling on the outer side of the knee.
A burning pain at the level of (or just underneath) the lateral femoral epicondyle when pressure is applied, which is a sign of inflammation at the lateral femoral epicondyle.

Potential findings of examination 
The force of hip abductors will be decreased.
Localised pain on the outside of the knee when pressure is applied.
A short or tight TFL which causes friction at ITB
Knee valgus, where the knees knock in.

Prevention and Treatment of IT Band Syndrome?
Stretching of the Gluteus Maximus and TFL and exercises to strengthen the hip abductors such as exercises like hip hikes, side lying hip abduction, the clam shell and fire hydrant.
Deep tissue massage to trigger points in Biceps Femoris, Vastus Lateralis, Gluteus Maximus, and TFL muscles.
Sports massage can be complimentary alongside a training programme.
Decreasing the intensity of training, especially running and promoting an active rest period is critical with athletes.