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The iliotibial band has neither woodwinds nor brass — oops, wrong kind of band! It is one of those anatomical structures that forms as a merging of several other tendons, etc., at the top outside edge of your pelvic rim and ends below the knee in several points. It is a thick sheet of dense fibrous tissue/gristle that travels from the upper pelvic edge on top of muscles along the side of the thigh, across the lower end of the thigh bone/femur bump, called the lateral epicondyle, and mainly ends or grows into the larger calf bone/tibia outside bump, the tibial tubercle. Its purpose is to stabilize bones while muscles move them.
The pain’s source is believed to originate from friction of the iliotibial band as it rubs on these bumps, especially the femoral one, during knee flexion-extension in running with a longer stride. It gets worse when running up and down hills. The pain feels most intense when the heel strikes the ground. Short-distance runners are much less likely to develop it. At first, the pain is spread over the entire lateral knee, then localizes to the epicondyle as it worsens. Pressure on that point will often produce the (ouch!) characteristic tenderness (yipe!). On occasion, the pain is deceptively referred to the hip.
Iliotibial band syndrome occurs in 4.3 percent to 7.5 percent of long-distance runners, but also in cyclists, tennis players, adolescents in a rapid growth phase, and military recruits — but not members of the band. Men and women are affected equally, fair odds for a change. No known association exists with race genetically (but definitely if you’re in the race!). The predisposing factors (aside from running, obviously) are not clear. Guesses include pre-existing iliotibial band tightness, weak knee and/or hip muscles, excessive knee rotation toward the inside to start with, and pronation, when the foot tips down to the inside.
Tests beyond the physical exam are seldom needed. An MRI will show a thickening of the iliotibial band over the bone and a collection of fluid under it. X-rays of the knee may be needed to rule out other issues, such as fracture or bone spur. The list of other problems to consider in the differential diagnosis includes hamstring strain, medial and lateral collateral ligament injury, cartilage injury, other muscle/fibrous tissue pain, arthritis, bursitis, patellofemoral syndrome, joint sprain, referred pain from spine and stress fracture. That’s all.
Treatment is usually conservative. The main principle is, “if it hurts, don’t do it.” Modifying the running/ cycling program is absolutely necessary. That “kills” the patient, sort of like asking them to walk on hot, burning coals. But ya gotta. Examining the biomechanics of the leg, and perhaps looking at different shoes, can be done in physical therapy. Certain exercises are recommended to stretch the iliotibial band and strengthen muscles around knee and hip. Anti-inflammatory pills can be an adjunct, say ibuprofen types. Sometimes a cortisone injection into the area will decrease inflammation faster. For the tough ones, surgery could be in the cards. That might mean a “release” or cutting of the iliotibial band in the back where rubs on the bone. In a study of 45 such patients 84 percent reported good to excellent results.
Should you run into iliotibial band syndrome, you are not getting the “run-around” if you are told to slow down. The word syndrome means a running (dromos) together (syn). So run with the recommendation.
A hurting knee is an injured one. A happy knee is a healthy one. Can’t you just look down and see your knee smiling at you when is it pain free? If you can, maybe we have another problem?
