Member Case Study: Iliotibial Band Syndrome (ITBS).

author : AMSSM

comments : 1

My early (self) diagnosis was strained lateral ligaments, but I'm now wondering if it's an overuse injury affecting my ITB? Anyone have any experience in diagnosing this one?

Question
My left  knee lateral ligament has been hurting since a half marathon two weeks ago. Never had knee problems before and I can't seem to shake this one. After hobbling around for sevearal days following the race, I went for a run and had to quit early because the knee pain returned!

Resting for a further 4 days and being clear of pain when walking around, I went for a run on Sat. and the pain was back. My early (self) diagnosis was strained lateral ligaments, but I'm now wondering if it's an overuse injury affecting my ITB? Anyone have any experience in diagnosing this one?

Answer

There exists a very common overuse condition in long distance runners called iliotibial band syndrome (ITBS). As the medical director for the P.F. Chang’s Rock & Roll Marathon and ½ Marathon in Phoenix, AZ every January, I see a lot of runners with this problem at this time of the year as training intensity increases.

ITBS occurs from excessive friction of a fibrous band that runs from the hip to the knee over a portion of bone in the knee called the lateral femoral condyle. Runners with this condition usually have pain approximately 2-3 centimeters (1 inch) above the knee joint laterally. Pain usually does not occur at rest and sometimes it takes 2-3 miles of running before having pain. As the severity increases, pain will occur sooner in a run.

There are many causes for ITBS but they can be divided into two broad categories: extrinsic and intrinsic factors. Extrinsic factors include the training surface (i.e., running downhill/uphill, road vs. track, etc.), training intensity, footwear, etc. Intrinsic factors are related to how an athlete’s body reacts to training. For example, a runner with weak proximal hip abductors or forefoot supination may be at a biomechanical disadvantage when they exercise. Over time these extrinsic and intrinsic factors can lead to numerous overuse injuries including ITB syndrome.

Treatment of ITBS is directed at eliminating training errors, modifying biomechanical problems (i.e., with orthotics), and symptom relief. Sometimes the only thing a runner with ITB syndrome needs is activity modification and/or a stretching routine for the iliotibial band. I usually will prescribe an anti-inflammatory medicine such as Aleve or Motrin for a week or two. If a patient is not improving, or has a moderate case to begin with, I will refer them to a physical therapist for directed rehabilitation. The entire kinetic chain of the lower extremity needs to be addressed. Rarely, I will perform an injection of the IT Band. There are reported cases that have needed surgery, but I have never personally had one go that far.

If you continue to have problems or the explanation above doesn’t sound exactly like what you are experiencing, I would recommend looking for a sports medicine physician in your area. You can find one at this link http://www.newamssm.org/FADquery.html.

Hope this helps,

J. Todd Davis, MD
Team physician, Arizona State University
Medical Director, P.F. Chang’s Rock & Roll Marathon and ½ Marathon
Founder, Sonoran Sports & Family Medicine, PLC

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date: November 27, 2005