Physical Therapy for IT Band Syndrome
Iliotibial band syndrome (ITBS) is a common overuse injury among runners and cyclists in which the IT band becomes inflamed and painful due to repetitive stress on the IT band. The IT band is a thick band of connective tissue that extends from the pelvis to the tibia, connecting to the outside of the tibia just below the knee. ITBS can result from repetitive exercise, excessive or incorrect training, faulty biomechanics, and muscle tightness and weakness in the core and hip musculature. Physical therapists can treat IT band syndrome to lessen pain, restore movement, and return to activity and sport safely through targeted strengthening, gait training, manual therapy, and functional training.
What is the IT Band?
The Iliotibial (IT) Band is a thick band of fibrous connective tissue that extends from the pelvis to the tibia, running along the outer length of your thigh and connecting the outside portion of the tibia to just below the knee joint. As the IT band gets closer to the knee, its shape thickens as it crosses over the femur and attaches to the tibia. Along with the quadriceps muscles, the IT band provides stability to the outside of the knee joint during movement.
What is IT Band Syndrome?
Iliotibial band syndrome (ITBS) is one of the most common overuse injuries of the leg, particularly in athletes of endurance sports. ITBS accounts for 12% of running injuries and 24% of cycling injuries. The ITBS pain is thought to be caused by the friction and compression of the connective tissue (IT band) on the outer thigh when moving. When the IT band is overused, the repetitive stress on the tissue causes friction across the bony femur as the knee flexes and extends, causing the IT band to become inflamed, swollen, and painful. ITBS pain can result from excessive contact between the IT band and thigh bone, poor alignment and muscular control of the lower body, or prolonged pinching or rubbing forces during repetitive activities like running, cycling or squatting.
Symptoms of ITBS include:
Stabbing or stinging pain along outside of the knee
Clicking, popping or snapping on the outside of the knee
Swelling near the outside of the knee
Feeling of the IT band snapping over the knee as the knee bends and straightens
Occasional tightness and pain at the outside of the hip
Continuous pain after activity, especially after walking, climbing, descending stairs, or moving from sitting or standing
Pain that is more intense when the knee is slightly bent, during downhill running, or right before or after the foot strikes the ground (this is when the IT band rubs most over the thigh bone)
Common causes of ITBS include repetitive exercise, excessive or incorrect training, faulty biomechanics, and muscle tightness and weakness in the core and hip musculature. ITBS can result from a training load error in which a runner rapidly increases running distance or switches to increased downhill running or new trails that challenge and stress the body in new ways. If the IT band is not transferring load properly or there are abnormal mechanics of the lower body (hip, knee, and ankle), ITBS can result.
Physical Therapy for IT Band Syndrome
Physical therapists can treat IT band syndrome to lessen pain, restore movement, and return to activity and sport safely. When an athlete comes in with IT band pain, the therapist conducts a thorough evaluation including a movement analysis (walking, running, foot structure, balance, and lower body alignment) as well as assessing the range of motion, strength, and flexibility of the hip, knee, and ankle to determine the mechanical issues that are causing ITBS.
Physical therapy treatment for ITBS can include:
Gait training to minimize stress on the IT Band and ensure proper alignment and mechanics when walking and running.
Muscle strength training to improve the strength in the legs and reduce tension in the IT band. The therapist targets the hip and the glutes for strengthening, particularly the gluteus medius muscle as it plays a role in maintaining proper knee alignment when walking or running. Strengthening the core is also important to provide a strong, stable base of support for the movement.
Range-of-Motion Exercises to relieve symptoms, including glute and quadricep stretches, deep lumbar rotations, and rotating IT band stretches.
Plyometric training to work on improving the power of the IT band before progressing to running training.
Manual therapy: soft tissue mobilizations of the lumbosacral spine, hips, and knee to improve muscle tone and myofascial mobility.
Functional training: as the athlete regains motion and strength, the therapist retrains the athlete to perform controlled, coordinated sport-specific movements.
IT Band Syndrome can cause debilitating pain and limit an athlete’s ability to run and engage in their sport. Work with a physical therapist today to reduce IT band pain and restore movement so you can safely return to sport!
