Iliotibial band syndrome

Cause of disease

iliotibial band complaints result from the iliotibial band being compressed against the thigh at a knee flexion of 20-30 degrees. This entrapment is the result of an abnormal movement pattern, swelling or anatomical influences that restrict the iliotibial band's space.

Despite the physical advantages of the iliotibial band, complaints are usually due to physical factors. Muscles may be too weak, too short or show a poor activation pattern (read more). In addition, joint mobility can be limited by various factors: a traumatic event (e.g. you have fallen on your hip), excessive repetitive strain (e.g. a lot of walking or hiking) or a muscle length deficit leading to a joint limitation. These can occur at the hip, knee and / or ankle. If physical factors are the cause, this usually leads to a narrowing of the space where the iliotibial band is located and an entrapment occurs. If this is short-lived, it will not cause many symptoms. This also explains why the pain only occurs and gets worse after many repetitive movements such as walking, hiking or cycling during which the iliotibial band is overused.

The complaint itself is mainly caused by the internal rotation and adduction of the upper leg (the knee turns inwards). This increases the tension and stress on the iliotibial band, which causes it to be more tightly clamped against the upper leg.

Evolution of the clinical picture

The complaint manifests itself as a painful area on the upper-outer side of the knee during slight bending (about 20-30 degrees of knee flexion). Exceptionally, it can also occur at hip level. The pain usually occurs after prolonged activity (e.g. walking, running or cycling), increases as activity is continued and is typically worst when walking or running downhill. In addition, the symptoms occur earlier and earlier during exercise if not treated.

Articular

Rarely are there specific complaints at the joint level. If the complaint is present for a long time and there is a compensation pattern to relieve the knee, this can have an impact on the hip, lower back and knee.

Muscular

• Sensitivity to pressure in the vastus lateralis (outer leg)
• Sensation of pressure in the superficial and deep gluteal muscles.

Neurologic

None

Other symptoms

Sensitivity to pressure in the iliotibial tract (outer side of the thigh)

Physiotherapeutic examination

During the examination, we check whether the patient's movement pattern is abnormal, causing the iliotibial band to experience excessive pressure in different tests. We then examine whether the musculature and the joints (e.g. muscle length or lack of strength and excessive tension) (e.g. movement restriction at the hip or leg length difference) contribute to the abnormal movement pattern.

Physiotherapeutic treatment

The treatment consists of 3 areas aiming at a return to normal activity. In the first stages, pain control and manual therapy will be the most important. Rather quickly, exercise therapy will come into play and play a key role in restarting activities and avoiding relapses.

Manual physiotherapy

If there are muscle length deficits or joint restrictions, we will try to normalise the mobility by stretching, mobilising and manipulating techniques.

Pain control

The iliotibial band is often over-stretched due to compression. This is a protective reaction that maintains the complaint. We therefore aim to relax the ITB through massage, trigger point and dry needling techniques. Other muscles that are excessively tense are also treated (e.g. Gluteus minimus).

Exercise therapy

To limit compression of the ITB on the thigh, we must train the coordination of the gluteal muscles to avoid excessive internal rotation of the knee. In the first phase, we train the gluteal muscles in isolation. Later on, we aim to perform exercises involving a stepping and/or walking movement. By doing so, we teach the patient to tighten the right muscles at the right moment. Finally, we aim to improve the strength and endurance of the new coordination pattern in the context of prevention and the patient's specific needs.

Short term

In this first phase, we mainly try to reduce the pain response. You can therefore expect less pain during activities. It remains important to limit the duration and intensity of the activity. Usually, but not always, the provoking activity should be stopped or reduced to a minimum.

Lang term

Ilitiobial band syndrom is often a chronic condition that develops slowly and can last a long time. Since a new movement pattern has to be learned, the entire rehabilitation process also takes a long time. After 2-3 months, we aim that the new coordination is automated for walking activities and short jogging sessions. If the patient aims to further build up the walking and running volume or intensity, a longer follow-up is recommended. This is to ensure that the coordination pattern is also performed correctly under fatigue.