Iliotibial Band Friction Syndrome – Too Much of a Good Thing

Iliotibial Band Friction Syndrome – Too Much of a Good Thing

When Fred limped into my office, he was not a happy camper. He had just run the Houston Marathon (his 80th marathon, by the way!), and his left knee was killing him. The pain started at mile 10 and was so intense he was forced to walk the remainder of the course. Not something a veteran marathoner — or anyone, for that matter — wants to experience.

While taking Fred’s history I learned that he’d had several episodes of similar knee pain in the past, but never this severe. Most of the pain was focused on the outside (or lateral) part of the knee, but he also had pain up the side of his thigh. In the past he’d just stopped running until his knee stopped hurting. His evaluation confirmed my suspicions.

Fred had Iliotibial Band Friction Syndrome (ITBFS). It sounds scary, but it’s great news! ITBFS is an overuse syndrome, otherwise known as “too much of a good thing”. The iliotibial band is a long tendon that runs down the outside of the thigh, crossing both the hip and knee joints. It connects the glutes, tensor fascia latae muscle and pelvis to the lower leg and kneecap.

Friction of this band against the side of the knee can cause inflammation, scarring, and subsequent shortening of the ITB. And since the friction is caused by bending at the knee, runners and cyclists are especially prone to this injury. Shortening or contraction of the ITB increases tension on the outside of the knee, forcing the knee and kneecap to move abnormally, which causes pain. And this pain can be exquisite. So what’s the great news?

ITBFS is remarkably easy to fix. Depending on the number of complicating factors (like muscle imbalances, faulty footwear, running surface issues, joint restrictions, etc.), our treatment protocol usually resolves the problem in less than a month. No drugs or surgery. A typical treatment program may look like this:

*Myofascial release, to lengthen the ITB and break up scar tissue*Balance training, to speed muscle response time*Core training, to increase stride efficiency & distribute stresses more evenly*Joint manipulation, to restore normal joint movement*Eccentric exercises, to increase tendon strength*Training & dietary consultation

And once the tendon is longer, stronger & pain-free, it’s easy to keep it that way. A simple knee maintenance rehab program is all it usually takes, along with some rules of thumb about training techniques. Even though we’ve talked about ITBFS as it relates to endurance athletes, it can occur in non-athletes — or ‘normal’ people — too! If you think you may have it, consult with a good chiropractor or physical therapist. You may be surprised how simple the solution is!

NOTE: For those of you who were wondering, Fred is currently training for and running an aggressive marathon schedule. He’s had one mild recurrence of his knee pain in the 2 years since his initial episode, which we easily resolved with a few treatments. Keep on running, Fred!