Ilio-Tibial Band Syndrome (ITBS)

by Dr. Timothy J. Maggs, © 1999

For many who ultimately join the ITBS Club, the injury has similarities to a bad neighbor. Your initial hopes are that it isn't really there, but as the pain worsens and reality sets in, you slowly begin to go through personality changes, weight loss and even marital problems due to the tremendous aggravation and stress it produces.

For those unfamiliar with this very common syndrome, pain on the outside of the knee that worsens with time should be considered as ilio-tibial band syndrome until proven otherwise. It can become a debilitating condition and, unless the underlying cause is addressed, it generally will return.

Causes

The primary cause of this condition is that it is a repetitive motion disorder; that is, we repetitively use the involved muscle without ever allowing full recovery. Our body's defense system produces an inflamed situation, which we feel as pain, tightness and swelling, so we hopefully obey the laws of life a little and stop the offending exercise and work to correct the condition. The underlying and influencing factors that contribute to the onset and duration include leg length difference, worn shoes, uneven running surfaces, increased mileage and lack of proper warm up and cool down. All of the thigh muscles, including the quads and hamstring, are victims of this repetitive motion in runners and are vulnerable to the same fate. Repetitive motion disorders are also commonly found in industry today and manifest as carpal tunnel syndrome and low back pain. These are but two of the more common work related injuries causing severe financial burdens and frustrations to many employers and employees alike. All too often, treatment deals only with the symptoms, and this condition requires causal treatment to alleviate it.

Primary muscles used in any activity repetitively require specific attention or they will slowly tighten due to an accumulation of unwanted toxins and a reduction of normal blood flow (nutrition and oxygen) to the muscle. The situation producing symptoms experienced in and about the knee are similar to the tightening of a violin wire. As the muscles of the front and lateral (outside) thigh begin to tighten due to increased exercise and a diminishing supply of blood flow, the tightening begins to affect the ilio-tibial band, and that's when symptoms begin.

Correction

Much like any other structural condition, corrections should be instituted based on logic, simplicity and cost. Surgery would never be my first recommendation to any runner, regardless of the degree of symptoms. The first step would be to incorporate some form of anti-inflammatory treatment immediately. This would accompany a "no running and no stretching" period to increase the likelihood of breaking the pain cycle without producing further damage. Icing for 20-30 minutes at a time (5-8 times per day) is a must. Some type of ace bandage or elastic support would also benefit the injury. An anti-inflammatory, such as motrin or naprosyn, is a good complement. All natural anti-inflammatories are preferred, such as bromelain, but any agent is better than none for the immediate interest in breaking that pain cycle.

Now that the inflammation is being addressed, the underlying cause must be addressed. The repetitiveness of the muscle use produces a congested, tight and contracted muscle/tendinous situation. Multiple massages on a daily basis to the muscles above the symptomatic sight is critical. It is mandatory to increase the blood volume coming to the muscle belly, while reducing the internal muscular pressure above the tendon in an effort to improve circulation, thus lengthening the muscle through relaxation of the fibers. This lengthening will take much of the stress off the tendon and allow the healing process to begin to go to work.

There are a couple methods for massaging the involved area. One is to have a friend work the lower half of the outside of the thigh with their thumbs for 20-30 seconds at a time. This can be repeated 4-5 times per day to encourage blood volume to the muscle. The massage should start about half way