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Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome(ITBFS) also known as ?runners knee? is a

very common athletic injury that effects the knee. Runners knee is especially prone

to long distance runners or athletes who participate in activities that require highly

repetitive running. In greater detail I will be discussing the causes of this injury

specifically the biomechanics, anatomy and symptoms involved, also ways of

preventing this injury by identifying common training errors and the appropriate

training modifications needed, and finally a variety of ways for treatment and

rehabilitation to help improve the injury.



The iliotibial band is a thick band of tissue that extends from the thigh(femur)

down over the knee and attaches to the tibia. When the knee bends (flexion) and

straightens (extension), the iliotibial band slides over the lateral femoral epicondyle,

the bony part of outer knee. Iliotibial band friction syndrome refers specifically to the

lateral knee pain related to irritation and inflammation to the point at which the band

crosses the lateral femoral epicondyle. This type of irritation occurs when the knee is

flexed at approximately an angle greater than 30 degrees, because the iliotibial band

shifts posteriorly behind the lateral femoral epicondyle. During extension, the band

shifts back anteriorly in front of the lateral femoral epicondyle and it is this motion

that causes friction between the iliotibial band and the lateral femoral epicondyle

which leads to irritation and inflammation within the iliotibial band.


Iliotibial band friction syndrome is a condition not unique to runners, it and its

symptoms are now frequently seen in cyclists, weight lifters, skiers and soccer

players. The most obvious sign that you have ITBFS is the pain felt usually during

exercise. Runners will describe the pain on the outside part of the knee or lower

thigh. The degree of discomfort runs from dull aching sensation to a sharp stabbing

pain. The pain is not localized so most suffers cannot put their finger on one

particular spot. Suffers will generally use the flat of their hand to describe the

location of the pain. One easy self test to know if you might have ITBFS, is the point

of tenderness test. A patient with ITBFS will exhibit extreme point of tenderness at

about 2 cm over the outside part of the knee when flexed at thirty degrees. Another

common symptom is a ?creaking? noise during activity, this noise mostly occurs

during weight bearing exercise like weight lifting. This is because during weight

bearing activities the additional pressure and compression forces the contraction of

the knee joint. This leads to elevated friction over the lateral epicondyle and

increased pain. One important factor about ITBFS is that it is a problem not inside

the knee joint, but around it, which makes more easily distinguishable and treatable.


Common Training Errors/Training Modifications:

Iliotibial band friction syndrome is an overuse injury caused by extensive

repetitive friction of the iliotibial band. The most frequent oversight runners and

athletes make is over doing it or over training. This can be controversial because if

you wish to compete at highly competitive levels what is over training? This should

be decided by the athletes themselves who should know when to make the rational

decision of knowing when to stop. Another predisposing factor for the development

of ITBFS is training error and abnormal biomechanics. Many runners make the

mistake of only running on one side of the road. Most roads are higher in the centre

and slope off on either sides. The foot on the outside part of the road is lower than

the other. This causes the pelvis to tilt to one side and tightens the iliotibial band

occurs, naturally increasing friction. Runners must always remember to try when

possible to run on flat terrain, this will greatly reduce the chances of acquiring

ITBFS. As running on flat terrain reduces friction, highly shock absorbing footwear

is also needed. In runners with normal feet, the force of running is dissipated by the

foot. However, if you have a minor abnormality in your foot anatomy, like high or

low arches, the shock from the force of the foot strike is primarily passed directly to

the knee. A good pair of shock absorbing shoes will decrease the pressure, inturn

allowing the muscles and tendons surrounding the knee, chiefly the iliotibial band to

be more relaxed reducing friction. Shoe mileage should also be considered for

serious runners or athletes. After about 500 miles or 800 kilometres most shoes loose

60% of their initial shock absorption capacity. As some one jogging leisurely or

training competitively, both should participate accordingly, knowing when not to

over do it, and knowing to implement good training habits like appropriate footwear

and stretching before and after performance. If these aspects of sport along with

others are followed avoiding ITBFS should be easily accomplished.



In establishing an appropriate treatment program, the severity of the present

inflammation must first be determined. Once the injury is properly assessed and the

diagnosis taken into consideration, the athlete may be placed into one of the three

phases of iliotibial band care.

The first phase of care is the Immediate Phase. This is the phase in which the

pain and inflammation must be controlled along with any poor training habits, which

some I already discussed are corrected. Achievement of these goals require a

reduction of activity and the proper administration of oral anti-inflammatories. If the

trainer sees fit, many alternate treatments may be implemented. Such as ice, heat,

ultrasound, and electrical stimulation. It should also be noted that stretching

exercises which are extremely important to combat any excessive iliotibial band

tightness are conducted in this phase.

The second phase, or the Short Term Phase becomes a consideration only if

the painful symptoms have not yet resolved within approximately 10 days of the

previous treatment. All the previous treatment should be continued with the possible

addition of a physician administering steroid injections, in two week intervals.

Further restriction of activity may be necessary. If deconditioning of the athlete

becomes a concern during this phase, he/she can participate in other activities like

swimming or cycling, as long as the activity remains pain free.

The third and final phase, the Long Term Phase is seen as an optimistical

stage. This phase begins only after the pain and inflammation symptoms have

resolved. This phase is typically in close association with the athletes return to sport.

During this stage, it is very important to prevent any reoccurrence of the resolved

symptoms. So a gradual return to play with extensive specific stretching exercises

both before and after workout is essential. If at this point pain and inflammation has

not significantly reduced, a return to play is not a good option yet. Your trainer or

physician should recommend further rest or surgery as a last resort.


Surgery is contemplated and seen only after many attempts of non operative

measures failed to relieve symptoms. Surgery is usually only required for those

individuals who are unwilling for many reasons, some very valid to modify their

sports participation. The surgery consists of making a 2cm incision in the posterior

fibres of the iliotibial band. This loosens the tendon some what but mostly allows for

space for the band to pass over the lateral femoral epicondyle without much of the


Iliotibial band friction syndrome (ITBFS) is an overuse injury that is most

common in those athletes that entertain highly repetitive running sports. It is seen in a

variety of athletes from soccer players to cyclists. It is the inflammation of iliotibial

band as a result of friction with the lateral femoral epicondyle. The injury is easily

detectable and the proper treatment and rehabilitation should be diagnosed. The

injury should be first be treated in a conservative manner by initiating the progression

of rest, stretching, and the moderate use of medications only if directed by a

physician. If all conservative attempts fail to achieve results then surgery might have

to be necessary. After doing this research paper I have learned a number of things,

but most importantly I believe I have learned what that pain on the outside of my left

knee that I have been experiencing for the last few months is.

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