By Olivia Heffernan, Physiotherapist
What is ITB Friction Syndrome?
ITB (Iliotibial Band) friction syndrome is a common overuse injury that affects many athletes and active individuals.
Runners are often the victims of this condition and it can be painful enough to stop you in your tracks.
Characterised by pain on the outer side of the knee, it can be a frustrating condition to deal with.
However, with the right exercises and techniques, you can effectively manage and even prevent ITB friction syndrome.
In this guide, we'll delve into the anatomy of the ITB, discuss the causes and symptoms of ITB friction syndrome, and provide a detailed list of exercises to help you overcome this condition and get back to your active lifestyle.
Understanding ITB Friction Syndrome
Before we dive into the exercises, let's take a closer look at what exactly ITB friction syndrome is.
The ITB is a thick band of fascia that runs along the outside of the thigh, from the hip to the knee. Its primary function is to stabilise the knee during movement and it is incredibly strong.
Previously the thinking went that when the ITB becomes tight or inflamed, it can rub against the outer part of the knee joint, causing pain and discomfort.
This friction is often exacerbated by activities that involve repetitive bending and straightening of the knee, such as running, cycling, or hiking.
But, the latest school of thought is that it's not so much a friction issue, and that the ITB is a tough band, that can't actually become tight, and the symptoms are caused by a compression of the bursae around the lateral knee, rather than a friction.
This compression comes about due to a weakness of the lateral hip abductor muscles, which attach at the top of the ITB.
This causes mechanical changes to how the hip and knee are functioning together, so the end result is compression, not friction!
Either way, it still hurts, so let's work out how to stop this ITB 'friction' problem. Overall, it's best that you just think about calling this issue ITB Syndrome. It's more accurate.
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Causes and Symptoms OF ITB FRICTION SYNDROME
Several factors can contribute to the development of ITB friction syndrome, including:
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Overtraining: Excessive or sudden increases in training intensity or volume can cause rapid rubbing or friction of the ITB on the lateral femur at the knee.
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Muscle Imbalances: Weakness or tightness in the muscles surrounding the hip and knee can alter biomechanics and increase stress on the ITB. Particularly the TFL (Tensor fasciae latae) muscle at the front of your hip which attaches to the ITB at your hip and therefore impacts the stretch the ITB is under.
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Poor Footwear: Wearing improper or tired footwear or running on uneven surfaces can also contribute to ITB friction syndrome.
Common symptoms of ITB friction syndrome include:
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Pain on the outer side of the knee, especially during activities like running or cycling.
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Swelling or tenderness along the ITB.
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Aching or burning sensation on the outer thigh or knee.
Now that we have a better understanding of ITB friction syndrome, let's explore some effective exercises to alleviate pain and strengthen the muscles surrounding the ITB.
Exercises we may suggest throughout your rehabilitation to alleviate ITB Friction Syndrome:
Clamshells:
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Clamshells target the muscles of the lateral hips, including the glutes and hip abductors, which play a crucial role with the ITB. Lie on your side with your hips and knees bent. Keeping your feet together, open your top knee as far as you can without rotating your pelvis. Often people with ITB friction syndrome will rotate their hips forwards or backwards as a compensation strategy. We like to suggest doing this with a wall behind you to avoid that rotation. Hold for a moment, then return to the starting position. Repeat for 10-15 repetitions on each side.
Side Leg Raises:
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Side leg raises strengthen the hip abductors and help improve hip stability, reducing stress on the ITB. Lie on your side with your legs straight and stacked on top of each other (again, you might like a wall behind you to ensure your legs are stacked on top of each other). Lift your top leg towards the ceiling, keeping it straight and your toes pointed forward. Lower back down with control. Aim for 2-3 sets of 12-15 repetitions on each side.
Hip Hikes:
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Hip hikes target the muscles of the hips and pelvis, promoting proper alignment and reducing stretch on the ITB. Stand on a step or curb with one foot hanging off the edge. Drop the unsupported hip downwards, then raise it back up by hiking the hip upwards. Perform 2-3 sets of 12-15 repetitions on each side.
Crab walks:
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Once your symptoms are starting to resolve we can work on lateral hip strength in a more functional position, like a crab walk. With a band around your knees or ankles, step sideways with tension on the band at the whole time. You can cover the length of your hallway or living room at home, moving in both left and right sideways stepping directions.
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Foam Rolling and muscle release:
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Foam rolling is an effective way to release tension in the ITB and surrounding muscles. Lie on your side with the foam roller placed under your outer thigh. Use your arms to support your upper body and gently roll back and forth from the hip to just above the knee. Spend extra time on any tight or tender areas. You may also like to use a massage ball or tennis ball into the muscles around the side and front of your hip. *** It must be noted that this doesn't actually lengthen your ITB, and won't fix your issue. You need to get stronger to really resolve the ITB compression problem.
Return to sport and activity:
Each case of ITB friction syndrome may be slightly different and respond in different ways.
These are just examples of exercises we may like to use in the early stages of your rehabilitation.
In addition to these, we will look at your running or cycling technique, global trunk, hip and lower limb strength and consider whether there are changes to your gym or exercise program we can make to alleviate your symptoms and avoid recurrence.
This is why it is important to be reviewed by a physiotherapist for the best advice and results.
ITB syndrome can be a painful and frustrating condition, but with the right exercises and techniques, you can effectively manage and prevent it.
Incorporate these exercises into your routine to strengthen the muscles surrounding the ITB, improve hip stability, and alleviate pain. Remember to start slowly and gradually increase the intensity and duration of your workouts.
If you're experiencing persistent or severe pain, be sure to consult with a healthcare professional for further evaluation and treatment.
Don't let ITB syndrome sideline your active lifestyle – take action today to get back on track to pain-free movement and performance.
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