Lateral Knee Pain

Lateral Knee Pain:
Iliotibial Band Syndrome

*Are you experiencing pain at the outside of your knee when you run? *Does the outside of your knee ache after sitting or climbing stairs?

Iliotibial Band Syndrome (ITB syndrome) is one of the leading causes of lateral knee pain in runners, bikers and athletes in all sports that involve a lot of running ­ yes, this includes soccer! The ITB is a broad thick band of fascia that extends from the top edge of pelvis, over the outside hip and along the outer thigh to attach just below the knee ­the longest tendon in the body. ITB Syndrome is typically considered an inflammatory condition that is due to friction (rubbing) of this band over the outer bony region of the knee. Inflammation of this fascia causes pain, a thickening of the tissue, and possibly restrictions to motion around the knee and hip.

Symptoms

• Typically described as lateral (outer) knee pain. It can however progress along the entire outer leg when severe, or cause pain at the lateral hip or into the kneecap.

• Individuals may feel a snapping of this fascia when the knee is flexed and extended.

• Pain often occurs midway through an event and lingers afterward, especially if running on hills or climbing out of the saddle.

• When the condition becomes more severe, pain may be present with sitting or stair climbing tasks.

• Prolonged or progressive symptoms commonly lead to poor patella (kneecap) tracking, a condition known as Patellofemoral Syndrome.

Common Causes of injury:

• ITB syndrome can occur from poor training habits or from poor
  bio-mechanical alignment during exercise. Some examples are:

• Running on banked surfaces such as the shoulder of the road or indoor track

• Running on uneven surfaces like trails

• Altered foot biomechanics ­ excessive pronation (arch collapse)

• Poor footwear­ old/worn shoes, improper fit or style for your foot type

• Running excessive distances or increasing mileage too quickly

• Poor flexibility in the hamstrings, iliotibial band, hip flexors or quads

• Hip/gluteal weakness or muscle imbalances causing altered running alignment

Treatment

Early treatment is key to avoiding secondary problems and thickening of the ITB. Individuals should focus on stretching the iliotibial band and temporarily avoiding aggravating conditions by limiting stair use, decreasing running mileage, and avoiding hills. The use of anti­ inflammatory medication (always check with your PCP) and/or ice can help with acute irritation. Proper lower extremity biomechanics and alignment are also very important in recovering from this condition.

Maintaining adequate control and strength of the quadriceps and gluteal (hip) muscles is essential to decrease friction around the lateral knee. Consideration of new or different shoes and orthotics as needed to correct biomechanics can be beneficial if the condition is persistent. Physical Therapy assessment can help provide insight and treatment for this injury as well as examination of your lower extremity biomechanics.

David Barlow DPT, OCS, BE Fit Physical Therapy