Member Case Study: Iliotibial Band Syndrome

author : AMSSM

comments : 2

So lately when I run after about 3 miles I get a nasty pain on the outside of my knee area. I have been assuming it is IT band syndrome? What can I do to help this?

Member Question from Jungle Jenn
So lately when I run after about 3 miles I get a nasty pain on the outside of my knee area....I have been assuming it is IT Band. It is getting very annoying as I have a very big race next weekend. I am trying my best to taper and today had an hour run so after about 20ish minutes it started bothering me again.....usually just my left leg. I pushed through it but walked a little here and there but I had to keep going so I could get back to the gym. After my shower I took a broom stick and just rubbed the area up and down and then both sides in the same place...actually tender to walk!

The running store changed my shoes from Asics 2120 to the new Pearls a couple months ago and they feel comfy and I have actually have PR'ed every race so far in them but I don't recall having these issues like this ever before...do you think it is the shoes? What can I do to help this before next weekends race? It is the Triple T so it will be a long long weekend.

Answer from Jeffrey Rosenberg MD, FAAFP

Lateral knee pain in a runner or a triathlete is often a frustrating experience for both the athlete and the physician. The most common source of lateral knee pain in a runner is Iliotibial Band Syndrome, caused by the iliotibial band becoming irritated by sliding back and forth across the lateral femoral condyle (the lateral bulge of the distal thighbone). It has been reported in 5% of long distance runners. When the knee is fully extended, the band (a thin muscle/tendon complex) is in front of the femoral condyle. As the knee is flexed to take a stride, this band slides over and then settles behind the condyle. The repetitive flexion and extension, which occurs while running and biking, irritates the tendon, causing it to thicken and become inflamed. The tendon and muscle will then become tighter, leading to more pressure while the tendon slides over the bone. There is a small bursa (a lubricating balloon) which can also become inflamed by this process.

Risk factors for Iliotibial Band Syndrome include excessive pronation or supination of the foot, having a varus alignment (bowlegged), leg length discrepancy, or having a crossover gait (when the leg is brought toward midline instead of straight ahead). The most common issue, however, is an abrupt or excessive change in training patterns, such as an excessive change in speed or distance, increasing hill work, running on a banked track or continuously running on the same side of the road. On physical exam, the ITB is tender just distal to where it slides over the lateral femoral condyle, or the bone itself may be tender. Likewise, strength testing of the ITB will increase pain, and often, the ITB is tight when tested (Ober’s test).

Treatment for Iliotibial Band Syndrome includes relative rest, pain relief with acetaminophen or over the counter anti-inflammatory medications, and using ice and massage over the painful areas. The most important aspects of treatment, however, are to increase the strength and endurance of the hip abductors and hip flexors. This can be accomplished on your own or with the help of a physical therapist or certified athletic trainer. Your running stride and shoe type should also be evaluated. Occasionally, a corticosteroid injection around the tendon or into the bursa is necessary to resolve the symptoms.

Jeffrey Rosenberg MD, FAAFP
CAQ Sports Medicine
Director: Primary Care Sports Medicine Fellowship
Mountainside Hospital
Montclair NJ

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date: July 15, 2008