The iliotibial band (ITB) is a ligament that runs from the outside of the hip to the knee. It helps to open the hip back, open to the side and rotate it. The iliotibial band also supports the knee.
Iliotibial band syndrome is one of the most common causes of pain in the outer part of the knee. This problem may occur due to the continuous movement of the band on the lateral femoral condyle at the lower part of the thigh (femur) bone. Repeated bending and opening of the knee due to overuse strains the ligament. As a result, the iliotibial band is injured, stretched and causes an immune system response (inflammation and edema). Pain may occur with a feeling of friction on the outer edge of the knee and knee movements. The pain may radiate to the hip. In fact, the iliotibial band can also be damaged, less frequently, at the level of the greater trochanter protrusion in the upper part of the thigh bone.
What Causes Iliotibial Band Syndrome?
The ITB starts from the upper anterior protrusion of the pelvis (spina iliaca anterior superior), and extends down the outer part of the thigh and knee. It is a thick, strong bond. When our knee is straight, the ITB stays in front of the inferior lateral prominence of the thigh bone (lateral femoral condyle). When we bend our knee more than 30 degrees, the ITB passes to the back of this bony prominence. Jumping over the bone every time the knee bends and opens can cause a problem at this point.
Iliotibial band syndrome may occur in runners, cyclists, tennis players, briefly in sports where the knee must be constantly bent and opened, with the mechanism we have described above. Tension of the iliotibial band increases the risk of injury. For this reason, it may be beneficial for people in the risk group to do exercises to stretch this bond. In addition, the weakness in the hip abductor muscles, which allows the hip to open to the side and prevents the hip from falling when one foot is on the ground, can cause more stress on the ITB, causing strain.
Structurally inverted tibia (tibia) below the knee, bent inward ( genu varum ) of the knee, and pronation of the foot are other problems that predispose to ITB.
Sitting for a long time with knees bent, going up and down stairs frequently and using high-heeled shoes can also cause ITB syndrome.
Errors That May Cause ITB Syndrome in Athletes
- Neglecting warm-up and cool-down movements
- Increasing exercise intensity suddenly excessively
- Not leaving enough rest periods between workouts
- Wrong choice of shoes
- Training on unsuitable ground
- Incorrect bike settings
- Loading up on exercise without getting in shape
ITB Syndrome Symptoms
Pain on the side of the knee is the most common symptom. Sometimes, pain can also be seen on the bony prominence called the greater trochanter on the outer side of the hip. Pain worsens with activities such as running, pedaling, climbing stairs. A crackling , massing or rubbing sound may be heard with every movement of the knee during walking and running .
If you have a complaint of pain in the outer side of the knee, it would be appropriate to first be examined by a physical therapy and rehabilitation doctor. The doctor first listens to your complaints and asks some questions. Then he inspects. In the examination, he examines the knee, thigh, hip region. Problems in the body part from waist to foot can cause problems that can be confused with iliotibial band syndrome. It is checked whether there is swelling, redness, and sensitivity by pressing in the joints. The comfort of knee and hip movements and whether there is a crunch or grinding sensation during movement are checked. Leg muscle strength and sensory examination of the skin are also important. If the problem is thought to be caused by ITB, a special examination method called Ober test can be applied. In the Ober test, the patient is laid on his unaffected side. The healthy leg is bent at the knee and hip. The painful leg is grasped by the doctor from the foot, the knee is kept bent at ninety degrees. The hip is moved back and up. Then the doctor slowly puts the leg down. If the ITB is normal, the hip descends painlessly. If the ITB is tight, the hip stays up; The patient may feel pain on the outside of the knee.
Injury and edema in the ITB can also be demonstrated with MRI. X-rays are taken to rule out possible bone problems.
Tension or injury to the hamstring muscles at the back of the thigh, damage to the lateral lateral ligament of the knee, external meniscus damage, patellofemoral pain syndrome, trochanteric bursitis are problems that should be kept in mind in the differential diagnosis, which can be confused with ITB syndrome.
In the treatment of ITB syndrome, exercises that stretch the ligament and muscles are applied first. Exercises that strengthen the hip muscles can reduce the stress on the ligament when returning to activity. Pain medications may be prescribed for a short time. In physical therapy, tools such as hot or cold applications, TENS, ultrasound, massage can be used. Injections containing cortisone (corticosteroid injection) are an effective method for relieving complaints. Recently, regenerative medicine methods such as PRP and prolotherapy have been increasingly used. With non-surgical methods, ITB syndrome heals in 3-6 weeks on average.
Tendon release surgery can be recommended in a small number of patients who do not benefit from exercise, physical therapy and needle treatments.