Runner’s Knee (iliotibial band syndrome-ITBS)

Runners knee or Iliotibial band syndrome (ITBS) is a common knee injury that comes through the doors at our Galway City physiotherapy and sports injury clinic. Patients with ITBS usually present with pain and/or tenderness on palpation of the outer aspect of the knee (above the joint line). It is considered a non-traumatic overuse injury and often seen in runners and cyclists.

ITBS is indicative of an underlying weakness of hip abductor muscles. The current theory is that this condition is likely to be caused by compression of the innervated local adipose tissue. Studies have described an ‘impingement zone’ occurring at, or slightly below, 30° of knee flexion during foot strike and the early stance phase of running. During this impingement period in the running cycle, eccentric contraction of the tensor fascia latae muscle and of the gluteus maximus causes the leg to decelerate, generating tension (compression) in the iliotibial band.

Clinically Relevant Anatomy

The iliotibial tract is a thick band of fascia that runs on the outside side of the thigh from the iliac crest (outer hip/pelvis) and inserts on the outside of the knee. It is composed of dense fibrous connective tissue that appears from the muscles of the tensor fasciae latae and gluteus maximus.

ITBS is one of the most common injuries in runners presenting with lateral knee pain. The etiology of ITBS is often multi-factorial. Long distance running is a common cause of ITBS, especially if running on slightly banked ground, as the subtle drop of the outside of the foot stretches the ITB, increasing the risk of injury. Sudden increases in activity levels can also lead to ITBS.

Treatment

The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment. As part of the treatment process, you can expect some of the following:

Activity modification and relative rest.
Myofascial release and trigger point therapy of tight and dysfunctional musculature.
Use of a foam roller on the tight muscles could also be beneficial.
Exercises to strengthen the abductor muscles and stabilise the hip. Since ITBS can often be associated with hip abductor weakness, strengthening and stabilising of the hip will be beneficial in the treatment of ITBS.
Gradual return back to sport under your physio’s clinical judgement.