ITB friction syndrome

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ITB friction syndrome
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Iliotibial band friction syndrome (ITBFS) is an overuse injury mainly affecting distance runners. It can also occur in cyclists, in team sport athletes who need to run long distances (e.g. soccer or hockey players) and in weightlifters. It basically does NOT occur in sprinters or court sport players (tennis, squash, basketball and netball).

Although it is allegedly easy to diagnose, some cases can be quite difficult to pin down. The features of diagnosis are:

	Pain occurs on the outside of the knee
	Pain is worse on slow straight line running and actually better on fast, change of direction movements (the opposite to most knee injuries)
	Pain gets worse the longer that running goes for
	Pain is worse running downhill than uphill or on level ground
	Pain can be severe once the band starts rubbing on bare bone. In this case it is relieved fully by walking with the leg totally straight.

Because the source of pain is outside the actual knee joint, the diagnosis can be confirmed 100% by running until pain comes on, then injecting the lateral epicondyle (point where the ITB rubs against the bone) outside the knee with a local anaesthetic agent. If this takes the pain totally away then the diagnosis is definitely ITBFS.

I have suffered ITBFS on both knees at different times of my distance running career. I have run a marathon with the benefit of a local anaesthetic injection that I gave myself and which lasted four hours (just enough to complete the marathon) when I had a severe case that only allowed me to run 5km without the injection before the pain became so severe.

Treatment of ITBFS

	Activity modification is the easiest treatment, if this is acceptable. For example, if you are a basketball player who has been trying to get fit by doing 10km hill runs, then if you stick to basketball the pain will go away.
	If you are a cyclist, lower your seat height.
	If you are a runner, reduce your distance per run, your downhill running, but if you like increase your speed.
	Use local measures to reduce the inflammation around the band (ice, anti-inflammatory gel, cortisone injections).
	Stretching is meant to help, but I am a cynic about this because I don't think it ever helped me!
	Gluteal (buttock) strengthening exercises and balance exercises probably help.
	Surgery is a last resort but almost always cures the problem (by taking the tension out of the ITB). An arthroscopy of the knee is not necessary if the diagnosis is certain, but is often performed if patellofemoral joint injury is also suspected.

A published scientific paper of mine on biomechanics of ITBFS - HTML format

Good summary of treatment of ITBS (external link)

Stretching exercises

Stretching exercises and anatomy

Stretching exercises with good photos

Yahoo search for ITBFS

Ability search on ITBFS

Physician Sportsmedicine review (technical)

www.runningspot.com

ITBFS described as one of the 'Big 5' running injuries