The iliotibial band (ITB) is a thickening of the connective tissue running down the outside of the leg from the pelvis to the knee. It has extensive muscular attachments to the pelvis and connective tissue attachments to the knee, as well as the underlying structures such as the hamstrings, quadriceps and femur. The role of the ITB is to assist in control of the knee and hip during tasks such as standing, walking and running.
What causes ITB-related pain?
The ITB often becomes irritated when under excessive stress, which can be attributed to any combination of increased/varied training load, poor recovery, change in shoes, poor nutrition & hydration, or lack of sleep. Due to the significant muscular attachments near the pelvis, poor strength and control around the hip and pelvic region are also major factors that need to be considered.
Why is the ITB important?
Due to the extensive muscular connections near the knee, the ITB can have a significant impact on knee function. Whilst it can become irritated itself, it must be considered as a factor when managing many other conditions around the knee such as patellofemoral pain syndrome (runner’s knee) and patellar tendinopathy (jumper’s knee).
Where do people go wrong treating ITB-related pain?
ITB-related knee pain is frequently attributed to ‘tightness’ within the ITB, rather than the excessive stresses placed upon it as described above. However, the ITB is incredibly strong and is able to withstand over 400kg of force before undergoing just a 1% change in length. Many people try and foam roll or massage the ITB in the hope of ‘releasing’ it, but this often causes a lot of pain and discomfort without any real change to the ITB itself. Whilst some people notice an improvement in symptoms following foam rolling, this is likely due to changes in the underlying hamstrings and quadriceps muscles, or improvements in vascularity and/or a reduction in neural sensitivity.
What should treatment look like?
The use of skilled soft tissue work around the hip and pelvic regions, as well as around the patella, should reduce some of the stress on the ITB. Completing this daily, along with identifying and addressing other sources of excessive load, should see symptoms ease within 2-3 weeks for cases that are being managed within the first week of symptom onset. These timeframes could increase significantly in cases that have been around a bit longer prior to seeking treatment, although every case will be slightly different. Once symptoms are manageable, improving the strength and function around the hip and pelvic regions will be a vitally important aspect of recovery, particularly in an active person. Without addressing the hip and pelvic regions, the likelihood of recurrence is significantly higher. A complete strengthening program might take in the region of 6-12 weeks, depending on the starting ability of the patient and the end goal. Complete recovery from ITB-related knee pain, including minimising the potential for future flare-ups, could take anywhere from 8-16 weeks depending on the factors at play.
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