Misconception about Iliotibial Band Syndrome

After working many years as a Physiotherapist I encountered a lot of patients/people suffering from Iliotibial Band Syndrome either from Athletes or ordinary working class people. They will usually complaints of pain from their hip/buttocks area to the lateral thigh to the lateral part of the knee. They will be either positive in Ober’s test or can be negative in the test as well. They will have tenderness upon palpation on the ITB.

For sometime, ITB Syndrome has been considered a ‘friction syndrome’ with the ITB thought to cause friction on the structures beneath it, leading to pain. More recent research however suggests that ITB pathology is more likely to involve compression of sensitive structures beneath the ITB rather than friction. This distinction is important as it has influenced treatment which has been targeted at stretching the ITB (to reduce friction) and steroid injections to reduce inflammation (e.g. in the bursa).

The ITB is a strong, complex structure with multiple attachments along the femur and distally around the knee. It provides stability for both the hip and knee joints and is thought to store and release energy like a spring. Current thinking is that a) you can’t stretch it; and b) you wouldn’t want to anyway!

The main culprit for this is loss of strength and control around the hip are thought to be key in the development of ITB Syndrome, especially weakness in hip abduction and external rotation, and increased hip adduction during loading. Treatment should focus on strengthening hip muscles especially Hip abductors, External Rotators and Extensors. Here are some of the exercises people can do at home.

Rehabilitation Protocols should be strengthening exercises of the hip, modify or reduce excessive activities, Education and Reassurance of patients. Physiotherapist like myself can definitely help with this condition and it is crucial to seek medical help during the early course of the syndrome for better outcome.