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Iliotibial band syndrome

Iliotibial band syndrome can cause lower thigh pain. We look at what causes this syndrome and available treatments.

elder woman holding painful swollen knee
Iliotibial band syndrome (ITB), which is sometimes called IT band syndrome or simply ITB syndrome, is a condition where pain is felt in the outer aspect of the lower thigh, just above the knee, when doing physical activities.

The iliotibial band is a thick band of connective tissue that runs from the outer aspect of the pelvis to the outer aspect of the shin-bone (tibia) just below the knee joint. It is attached to many of the muscles in the buttocks (gluteal muscles) and a thigh muscle called the tensor fascia lata (TFL) at the pelvis.

Hence, the reason that you may see this condition referred to as iliotibial band friction syndrome, or more rarely as iliotibial band tensor fascia lata syndrome.

Because of this connectivity to different muscles in the leg and hip, the IT band generates significant tension during sporting activities that involve repeated flexion and extension of the hip and knee, such as running and cycling.

IT band syndrome arises when there is weakness and lack of flexibility in the muscles that connect the hip and knee. Excessive tension through the IT band causes friction in the outer, lower thigh and this can sometimes be associated with pain in the soft tissue surrounding the muscles.

Normally IT band syndrome is the result of sharp increases in training intensity without adequate rest between training sessions.

The condition is most commonly found in people who do a lot of sports, such as athletes. It is often caused by combination of several factors, such as: ·       

  • Unbalanced, repetitive exercises, such as poor posture when exercising with weights ·      
  • Abnormal body alignment, such as bow legs, lateral pelvis tilting or unequal leg lengths ·       
  • Excessive training sessions, long-distance runners can be particularly prone to the condition ·       
  • Poor posture during certain sports, such as a cycling position that puts excessive strain on the knees and hips ·       
  • Muscle tightness or increased knee flexion during excessive squatting

IT band syndrome can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is significant tenderness along the IT band and the outer aspect of the knee over the area which the IT band passes.

Sometimes a clicking may be felt at the site of pain when the knees are bent.

X-rays and scans are not routinely required in the diagnosis of IT band syndrome.

Because people who are active are more prone to the condition, IT band syndrome symptoms are often noticed when doing sporting activities.

Pain and swelling is usually the first indication that something is wrong with that part of the body. Often symptoms are not felt initially but come on after running a short distance and are relieved by rest.

IT band pain can then be aggravated while jogging, cycling, during squatting movements or walking up or down stairs. It will normally be felt as a well-localised sharp pain on the outer aspect of the lower thigh. If symptoms are severe, there may be a clicking when the knee is flexed and extended as the IT band flicks over the outer knee.

Other IT band symptoms that are commonly but not exclusively associated with IT band syndrome include: ·       

  • Aching or a burning sensation on the outside of your knee    
  • Feeling a click or pop on the outside of your knee when you move    
  • Pain in the leg        
  • Redness on the outside of the knee

There are a variety of home remedies for IT band syndrome treatment. On most occasions the body will heal itself naturally.

The first course of action in IT band treatment is to tackle the pain. This can be done with over-the-counter pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to treat knee pain relief.

The following techniques can help you to manage the symptoms of IT band syndrome while your body heals.

Stop doing activities that aggravate the condition

The IT band may need four to six weeks of relative rest initially to settle symptoms. During this time, you can work on the specific strengthening of muscles and flexibility to improve your range of motion with a course of IT band exercises.

You may continue with any activities that do not aggravate IT band symptoms.

Iliotibial band syndrome exercises

IT band syndrome exercises that aim to strengthen and stretch the hip and thigh muscles. There is also a range of equipment is available to help with your recovery, such as an IT band foam roller, which is placed under the thigh to give support to the leg when doing certain exercises .

Examples of IT band stretches include:

Standing quads stretch with posterior tilt 

In each exercise, perform the five stretches for 30 seconds each.

This exercise should be performed twice a day

Side lying abduction

In each exercise lie on your side, perform three to four sets of 10 reps each.

This exercise should be performed three to four times a week.

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your doctor or physiotherapist.

If symptoms fail to resolve with a reduction in aggravating activities and home exercises, a referral to physiotherapist may be appropriate.

The physical therapist may recommend a course of therapeutic exercises. Physical therapy is particularly useful in alleviating IT band hip pain and IT band knee pain. It also very effective at managing the symptoms of IT band syndrome. Speak to your doctor or physical therapist before starting any exercise.

For those who are inactive or overweight and have been diagnoses with having IT band syndrome, weight loss and a gradual increase in general activity may be helpful in managing the symptoms as well as improving overall general health.

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