Iliotibial Band Syndrome (ITBS) is a common overuse injury that affects runners, cyclists, and anyone who engages in repetitive leg movements. As a PT who specializes in treating mountain athletes, I have seen it show up as achey or sharp pain through the lateral hip or knee with impact activity. With hikers and runners, symptoms are often worse on the downhill.

How can the McKenzie Method help with ITBS?

Iliotibial Band Syndrome (ITBS) can be a frustrating condition, but the McKenzie Method offers an effective approach to not only alleviate symptoms but also address the root causes. If you’ve tried strengthening and stretching to no avail, you may benefit from the Mckenzie Method. Your PT will investigate what spinal or musculoskeletal imbalances are contributing to your symptoms. We use the scientific method to determine what specific intervention(s) improve your symptoms. Many of our clients who have had acute and chronic ITBS have had great success with the McKenzie Method and have made progress within 1-3 visits.

What is Iliotibial Band Syndrome?

The iliotibial band (IT band) is a thick band of fascia that runs from the hip down to the outer knee. It connects the hip muscles to the shinbone, playing a crucial role in stabilizing the knee during movement. When this band becomes tight or inflamed, it can lead to pain and discomfort, often manifesting during physical activity.

Anatomy of the Iliotibial Band

Location: The IT band originates from the iliac crest of the pelvis and extends down the outer thigh, attaching to the lateral condyle of the tibia.
Function: The IT band helps with knee stability, particularly during activities like running, walking, and cycling. It works alongside muscles like the gluteus maximus and tensor fasciae latae to control hip and knee movements.

Common Causes of IT Band Syndrome

ITBS is primarily caused by repetitive activities that involve bending the knee, especially when running or cycling. Factors contributing to the development of ITBS include:

Overuse: uphill endurance athletes who also train on unstable surfaces can be prone to overloading the ITB because of repetitive prolonged impact.
Muscle Imbalances: Weakness in the hip and gluteal muscles can lead to improper alignment of the knee, increasing strain on the IT band. Oftentimes, endurance sports involve moving the legs forwards and backwards and not as much side-ways which can cause underdeveloped glutes and deep hip rotators.
Biomechanical Issues: Flat feet, high arches, or a difference in leg length can alter gait mechanics and contribute to ITBS. These issues can cause the knee to track improperly, leading to friction and irritation of the IT band.
Inappropriate Footwear: Shoes that lack proper support or cushioning can exacerbate symptoms by failing to accommodate individual foot mechanics. Finding a local running store that offers shoe suggestions based on a running gait analysis can be a helpful first step if you suspect footwear is an issue.

Symptoms of IT Band Syndrome

The most common symptom of ITBS is pain on the outer side of the knee. Other symptoms include:

Tenderness: Tenderness or swelling on the outside of the knee or hip.
Snapping Sensation: A snapping or popping sensation when bending the knee, often accompanied by discomfort.
Discomfort While Sitting: Increased pain when sitting for long periods or descending stairs, which can indicate irritation of the IT band.

Treatment Options

The good news is that ITBS is manageable with the right approach. Physical therapy plays a vital role in recovery and can include:

1. Rest and Activity Modification

Reducing or modifying activities that aggravate your symptoms is essential for healing. Cross-training with low-impact exercises, like swimming or cycling, can help maintain fitness without stressing the IT band.

2. Physical Therapy

A physical therapist can create a personalized rehabilitation program that focuses on:

Restoring postural imbalances: Oftentimes, those who have had little to no success with strengthening and stretching will benefit from a thorough exam of the spine to see if there are imbalances here. An assessment of the low back and repeated spinal movements can reveal any spinal involvement on ITBS.
Stretching: Gentle stretching of the IT band, hip flexors, and surrounding muscles can help alleviate tightness.
Strengthening: Targeting the hip, glute, and core muscles can improve stability and alignment, reducing strain on the IT band.
Manual Therapy: Techniques such as massage or joint mobilization may be used to relieve tension and improve mobility. Because of how thick and fibrous the ITB is, it is not often effective to dry needle the band itself, but needling the muscle that attaches to the top of the ITB (the tensor fasciae latae) and glute muscle can be an effective way to relieve tension through the hip and knee.

3. Foam Rolling and Self-Myofascial Release

Using a foam roller on the outer thigh can help release tension in the IT band and surrounding muscles. Self-myofascial release techniques can be beneficial in reducing tightness and improving flexibility.

4. Correcting Biomechanical Issues

If structural issues contribute to your ITBS, a physical therapist may recommend orthotics or suggest modifications to your footwear to enhance support and alignment.

5. Gradual Return to Activity

As symptoms improve, a structured plan to gradually return to your regular activities is crucial. This helps prevent re-injury and ensures a sustainable path to recovery.

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Understanding Iliotibial Band Syndrome: Causes, Symptoms, and Treatment