Runners Hip Pain - ITB

Iliotibial Band Syndrome - An MSK Therapy perspective

Many active and non-active people have no doubt encountered Iliotibial Band (ITB) pain, at some point in their life. Excessive ITB tension can create multiple problems within the "Kinetic Chain" , and these can lead to other injuries (see the related articles section). As with other injuries/conditions, Iliotibial band syndrome can become chronic, resulting in Persistent Pain. The chronicity of a condition adds further complexity to any treatment for many factors, including the possible presence of multiple conditions. However, good outcomes are still possible with the correct approach.

Another name of ITBS is "Runner's Knee", as it frequently affects runners and the knee. Confusingly, Patellofemoral Syndrome is also often called "Runner's Knee" and "Rowers Knee", and the two conditions affect different parts of the knee. Many Sports Injuries have alternative names due to such injuries commonly occurring in certain types of sport. Many sports involve repetitive motions, which can easily lead to injury and inflammation due to changes in Biotensegrity and how everything is connected

Anatomy and the ITB

The Iliotibial Band is a thick band of "fascia" which runs along the lateral (outside) portion of the thigh to the knee. Fascia is a type of tough connective tissue, consisting mainly of collagen fibres. There are also specific fascia sheets throughout the body that separate muscles and internal organs. The fascial network also helps transmit mechanical tension, supports movement and is involved in myofascial pain. Fascia also provides shape to muscles, reduces friction between these structures and is thought to have sensory capabilities, be they biochemical or neurological. The fascial material is particularly slippery and robust when fully hydrated, which are essential for correct functioning. Muscles cannot slide across each other efficiently if the fascia is dysfunctional. Trauma and overuse can result in changes to soft tissues and fascia, resulting in myofascial trigger points.

The Iliotibial Band attaches to the Tensor Fascia Latae (TFL), (not an exotic type of coffee). The TFL also has a fascial attachment to the Gluteus Maximus muscle. The diagram below demonstrates how these muscles are related and connected. The white sections between the muscles are the fascial connective tissue.

Image of the Iliotibial band

Images produced with kind permission of 3d4medical.com from Essential Anatomy 5

Possible Iliotibial Band Syndrome Symptoms

ITB Syndrome “Runner’s Knee” is a fairly common problem for runners and is usually characterised by:-

Lateral (outer) knee pain
Pain that is made worse by running or knee bending activities (repetitive)
Possible swelling and tenderness on the lateral aspect of the knee.
Gradual symptom onset provided no apparent trauma.

Possible Causes

There are many possible causes for Iliotibial Band Syndrome, such as:-

Trauma affecting the knee.
Muscles imbalances due to muscular dysfunction.
Changes in general biomechanics, affecting the kinetic chain.
Footwear.
Changes in training (speed, duration, terrain).
Failing to warm-up and or cool-down.
Habits and behaviours

It may seem surprising, but our sleeping position can contribute to ITBS symptoms. How we sleep can change loads on tissues and structures, effectively increasing or decreasing loads. Hence, changing our sleeping position when experiencing symptoms of ITBS can prove helpful, even if this does not address the root cause.

Professional help and identifying the reason for symptoms

For any form of treatment to be effective, one first needs to identify the reason for the symptoms of the problem rather than just treating the symptom. Regarding treatment, it is essential to not look at the Iliotibial Band in isolation and to bear in mind the Iliotibial Band is not a muscle. Hence, it has always seemed rather pointless, not to mention painful, to use a Foam Roller to, in effect, try and stretch a thick band of fascial tissue. The foam roller article discusses the Iliotibial Band and correct foam roller usage in more detail. Much like ligaments, the fascia operates partially structurally, though it affects function too, and people tend to avoid deliberately stretching ligaments (another type of collagen-based connective tissue). However, fascia also has elastic potential and the ability to store said energy while being stretched, hence another reason not to bother trying to stretch it. The energy from the stretch will just get saved until the stretch is released, so it serves little purpose. From a professional point of view, the author has never seen a case of Iliotibial Band Syndrome in the time that he has been treating musculoskeletal conditions (since 2006) that the Iliotibial Band caused. The Iliotibial Band tension was just the symptom in every case, and a tight Iliotibial Band can create rubbing on the lateral aspect of the knee or hip. Repetitive motions and friction usually lead to microtrauma, inflammation and pain. Pain often leads the body to subconsciously adopt pain avoidance strategies, which can affect other aspects of the body and kinetic chain (see the Soft Tissue Adaptation article for a more detailed explanation). Issues with the knee, ITB and hip can also have relevance to back pain .

In cases of Iliotibial Band Syndrome, the author has consistently found there to be both structural and functional changes resulting in irritation to underlying tissues. By structure, the author refers to joint-structure mechanics and function, which relate to changes in compressive and tensional forces within soft tissues. There is frequently a "chicken and egg" situation, as structure affects function and vice versa. To date, it has usually been possible to resolve Iliotibial Band Syndrome in one treatment through a combination of musculoskeletal techniques (for structural aspects) and soft-tissue therapy (for the functional component). The author tends to use the soft-tissue methods advanced Myofascial release techniques with their origins in Osteopathy. Hence, it is worth finding a professional and the article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective provides some hints and tips for finding a patient-centred practitioner.

Self-treatment

General stretching can often give some temporary relief, though it tends not to address the actual cause, which could be anywhere in the “kinetic chain”. Self-massage Foam Rollers and self Trigger Point Therapy (TPT) can also prove useful and provide some relief. However, applying either self-treatment technique correctly to tissues can often be quite difficult. Also, one needs to self-diagnose the actual cause of the problem before treating the identified tissues. Ideally, one should seek a suitably qualified professional who can then identify and address the reason for ITBS symptoms.

The article was written by Terry Davis MChiro, GradCertMentHlth, BSc. (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

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About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy and Myofascial Release Techniques methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.