Iliotibial band syndrome
Who gets it?
This post is on a common running injury called Iliotibial band syndrome, also known as runner’s knee. This injury is more common in women, this is probably due to the fact that women tend to suffer from their knees being knocked in (also known as Genu Valgum) more than men. However this problem has been known to occur in people with bowed legs (Genu Varum). The reason for females having a higher likelihood of their knees being ‘knocked in’ is still contested. The most common theory is because females have a wider pelvis to give birth and therefore wider hips and a different center of gravity compared to men.
What is the Iliotibial band?
The Ilio Tibial Band (ITB) is the longest tendon in the body, it originates from the anterior iliac crest outer lip, anterior border of the ilium and the outer surface of anterior superior iliac spine. As well as from the Gluteus Maximus and Tensor Fascia Lata muscles (In normal words that is an area of the upper outer edge of the pelvis, the muscles originating from the very front upper outer region of the pelvis and part of your bum muscle). Previously thought of as just a connective piece of tissue, recent research has found that tendons and fascia do in fact often contain smooth muscle fibers. ‘Smooth’ muscle fibers are the type more often found in the gut, ‘striated’ fibers are found in the muscles of movement attached to the joints. It aids in leg abduction (leg raising directly out to the side) and force distribution through the leg, it is also an important player in producing fascial tension that supports the Thoraco Pelvic Canister and therefore the lower back.
So what happens?
ITBS is now thought to occur as a result of the ITB rubbing against the side of the knee and irritating the bursa at this point. The previously followed theory of band thinkening is now less commonly followed.
Do In-soles help?
Insoles can be useful depending on the condition of the clients feet. If they are severely flat footed or have a rolling gait then an insole can make a very big difference in ruling out the foot as a contributing factor (at least in the short term). There are ways of correcting foot faults though they are too large of a topic to cover here.
What can I do about it?
A Manual therapist can help guide you through the two phases of treating runner’s knee. Stage one is looseing all the muscles that are contributing to the injury Tensor fascia lata and gluteus medius are the main players here. Once they are loosened you can then work on strengthening them and correcting the sequence in which they fire. Not following the correct phases of treatment for this injury can lead to a long recovery time. These are known as chronic injuries as they can last a long time if not correctly managed. It is a common misconception that merely loosening the ITB will solve your ITBS.
Clinical tip: You’ll know if you are seeing a good therapist if they assess the whole lower limb, not just the knee ;-).