Treating Knee Pain and Iliotibial Band Syndrome
Learn how to Treat and Prevent Knee Pain caused by Iliotibial Band Syndrome.
by Brad Walker | First Published October 22, 2002 | Updated September 28, 2018
Knee pain, as a result of Iliotibial Band Syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints.
Knee pain caused by iliotibial band syndrome is very common among runners and cyclists. However, the knee pain doesn’t usually occur in an instant, like a hamstring strain or groin pull, but commonly starts off as a twinge or niggle, and progresses quickly to debilitating knee pain that can sideline the best of us for weeks.
What is Iliotibial Band Syndrome?
For those who aren’t familiar with Iliotibial Band Syndrome, let’s start by having a look at the muscle responsible for the problem.
The iliotibial band is actually a thick tendon-like portion of another muscle called the tensor fasciae latae. This band passes down the outside of the thigh and inserts just below the knee.
The diagram to the right shows the anterior (front) view of the right thigh muscles. If you look towards the top left of the diagram, you’ll see the tensor fasciae latae muscle. Follow the tendon of this muscle down and you’ll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band. Or iliotibial tract, as it is labelled in the diagram.
The main problem occurs when the tensor fasciae latae muscle and iliotibial band become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.
What Causes Iliotibial Band Syndrome?
There are two main causes of knee pain associated with iliotibial band syndrome. The first is “overload” and the second is “biomechanical errors.”
Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner’s injury. When the tensor fasciae latae muscle and iliotibial band become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in-turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.
Overload can be caused by…
- Exercising on hard surfaces, like concrete;
- Exercising on uneven ground;
- Beginning an exercise program after a long lay-off period;
- Increasing exercise intensity or duration too quickly;
- Exercising in worn out or ill fitting shoes; and
- Excessive uphill or downhill running.
Biomechanical errors include…
- Leg length differences;
- Tight, stiff muscles in the leg;
- Muscle imbalances;
- Foot structure problems such as flat feet; and
- Gait, or running style problems such as pronation and supination.
Immediate Treatment for Knee Pain
Firstly, be sure to remove the cause of the problem. Whether is be an overload problem, or a biomechanical problem, make sure steps are taken to remove the cause.
The basic treatment for knee pain that results from ITB Syndrome is no different to most other soft tissue injuries. Immediately following the onset of any knee pain, the R.I.C.E.R. regimen should be applied. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
Ongoing Treatment and Prevention
Although the pain may be felt mainly in the knee, the problem is actually caused by the muscles that support the knee. Namely the tensor fasciae latae and the large muscle at the rear of your upper leg, called the gluteus maximus.
Other muscles in the lower back, hip, backside and upper leg also affect the function of the knee, so it’s important to pay attention to all these muscles. After the first 48 to 72 hours, consider a good deep tissue massage. It may be just what you need to help loosen up those tight muscles.
Firstly, don’t forget a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the leg muscles, which will result in a lack of oxygen and nutrients for those muscles.
Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity. Click here for a detailed explanation of how, why and when to perform your warm up.
Secondly, strengthening and conditioning the muscles around your knee and upper leg will help greatly to reduce the chance of knee injury and knee pain. If you are in too much pain to resume normal exercise, consider swimming, aquatic therapy, or maybe cycling.
And thirdly, flexible muscles are extremely important in the prevention of most leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement.
To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. The stretch below is one of the best stretches for the tensor fasciae latae.
Standing Abductor Stretch (1:24) Stand upright and cross one foot behind the other. Lean towards the foot that is behind the other. If need be, hold onto something for balance. This will allow you to concentrate on the stretch, instead of worrying about falling over. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
How to perform this stretch: Stand upright and cross one foot behind the other. Then lean towards the foot that is behind the other. You may need to hold onto something for balance.
How long to hold this stretch: Hold this position for between 20 to 30 seconds while concentrating on breathing deeply and slowly. Carefully move out of the stretch position and then repeat on the other side. Repeat 2 to 3 times on each side.
About the Author: Brad is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 100's of testimonials. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.