Iliotibial Band Syndrome

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About

Iliotibial (IT) band syndrome is appropriately also known as runner's knee. Although runners aren't exclusively affected, they are by far the most susceptible group.

If you have IT band syndrome, you will probably feel a stabbing pain or burning sensation on the outside of your knee during physical activity. This won't usually occur at the beginning of physical activity, but rather in the middle.

You have two IT bands, one stretching across the outer side of each leg. Each begins about half way up the outside of the thigh, almost as high as the hip, runs down over the outside of the knee and attaches at the top of the tibia (shinbone). As you bend and straighten your leg, the IT band slides over a bony bump on the outer portion of the knee called the lateral femoral epicondyle.

As you frequently bend and straighten your knee during physical activity, your IT band slides up and down more often over the lateral femoral epicondyle, similar to how a mountain climber's rope slides over rocks as he or she moves left or right. This causes lots of friction on the IT band, similar to the friction on the climber's rope. Over time, the friction can cause inflammation of the IT band and the pain associated with IT band syndrome.

That's why runners, particularly those who cover more than 12 miles (19 kilometers) a week for several months in a row, commonly experience the condition. Besides distance, running downhill is another contributing factor as it increases pressure on the knees. People who have poor foot mechanics while running are also at a greater risk of IT band syndrome, as conditions like over-pronation (excessive inward rolling of the foot) place more stress on the knees.

Not all runners will develop the condition, however, and some people who never run might. Activities that involve rigorous knee movements, like cycling and ballet, as well as a dramatic increase in physical activity can also cause the condition. Studies show that a number of other variables, including improper footwear, structural or functional problems in the legs and feet and duration of activity are also a factor.

If you have IT band syndrome, your healthcare practitioner can help reduce your pain and inflammation. He or she can also use a number of tools and techniques to help you return to activity and can recommend steps to help you prevent the condition from returning. One of those recommendations might be to reduce participation in knee-intensive activities, and until the condition heals you should probably avoid such activities entirely.

Anatomy

While the pain associated with iliotibial (IT) band syndrome occurs on the outside of the knee, the IT band, which is the injured structure, actually stretches across a large part of your thigh.

The IT band begins about half way up the thigh, almost as high as the hip, and is in fact connected with soft tissue structures of the upper thigh, like the gluteus medius muscle in the buttocks. From here, the IT band runs down across the outer side of the knee and connects to the top of the tibia (shinbone).

The IT band has many functions that help the leg perform properly. First, by covering the outside of the knee it helps prevent the knee from moving beyond its proper range of motion. Second, it provides an added layer of protection for the outside of the femur (thighbone). Third, it helps the knee move into a locked position when you stand straight with your leg fully extended. Finally, by its attachment to the thighbone and shinbone the IT band acts like a ligament, helping to connect the two bones.

While the IT band is a durable structure, repeated movement of the leg can cause it to become inflamed. As mentioned in the About section, every time you straighten your leg the IT band slides over a bony bump called the lateral femoral epicondyle. If you bend and straighten your leg repeatedly, it causes friction on the IT band that can damage it.

For that reason, long distance runners and people who participate in knee-intensive activities are at risk of IT band syndrome. If you have the condition or want to prevent it from developing, see your chiropractor for care and advice on how you can protect your knees.

Chiropractic Care

If you have iliotibial (IT) band syndrome and do a lot of running, the pain in your knee is probably becoming quite unbearable. While taking a vacation from knee-intensive exercises can help you avoid it, such a break may not be possible or desirable. Fortunately, conservative chiropractic care is an effective management for the condition, offering pain relief, restoration of the IT band and solutions to fix underlying problems and help prevent recurrences.

When you first visit your chiropractor with IT band syndrome, he or she will examine your knee and leg to check for dysfunction and positions that cause pain. Then, on subsequent visits, your chiropractor may choose to stretch the IT band, helping to loosen any stiff joints and tight muscles associated with the tendon. Your chiropractor may also recommend you apply ice to the area after you run or bike, which can help reduce inflammation.

It may also be necessary for your chiropractor to address subluxations (misaligned or stuck joints) in your spine if they have developed in response to your inflamed IT band. When you walk, the joints in your legs, pelvis and low back must work together. If any joint's movement is altered, it can change the movement of other joints and structures. Think of your body as a long chain of parts and the joints as the connecting links. If one of the links is broken or stiff, it can impact how the other links function, the same way a kink in a bicycle chain can prevent the chain from working properly. If an inflamed IT band is making your knee joint a dysfunctional link, your chiropractor may have to adjust other joints by applying a quick, strategic thrust that will shift them back into their normal position.

Other effective types of chiropractic care for IT band syndrome are physiotherapeutic modalities such as ultrasound and interferential current (IFC). Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve irritation, break down scar tissue and speed healing.

IFC works in a similar way, but involves electrical currents instead of sound waves. These painless, mild electrical currents penetrate the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the current at your knee, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain, as well as help decrease inflammation and accelerate healing.

Once inflammation and pain are under control, your chiropractor will probably focus on fixing any underlying problems that contributed to your condition and developing an exercise routine to help in your rehabilitation.

Factors such as the way you walk, the type of shoes you wear and the type of surface you run on can contribute to IT band syndrome. One problem that commonly contributes to the condition is over-pronation, which occurs when the foot and ankle overly rotate inward every time a person takes a step. This rotation can force the tibia (shinbone) and the knee to also rotate inward, which can cause the IT band to stretch further, making it tenser and therefore causing it to rub harder on a bony bump called the lateral femoral epicondyle.

If you over-pronate, your chiropractor can offset the problem by prescribing custom functional orthotics. If these are necessary, your chiropractor will take a casting of your relaxed foot, make molds from the casting and alter them to normalize your walking patterns. If you run and over-pronate, orthotics are even more important, as runners already place greater stress on their knees.

Regardless of your condition's cause, an exercise program is essential for restoring function to your knee. By regularly strengthening muscles in your leg, for example, you can help stabilize the knee and reduce the stress on its outer portion, where the IT band lies.

Finally, if you can't or don't want to stop performing activities like running and cycling, you should at least reduce the duration of your exercise until your IT band heals, and only then gradually return to more vigorous activity. You should also remember to consult your chiropractor before you begin or return to intensive exercise, to ensure that you don't aggravate your condition.

Iliotibial Band Syndrome

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