Band Syndrome (a.k.a., ITB Syndrome)
Kaley Abato, MSPT (on the right). Kaley is
PT for Bacharach Rehabilitation in Margate, NJ. She obtained
her Masters degree at Stockton and was also a student athletic trainer
here for 4 years..
band (ITB) is neither a muscle nor a tendon. It is a thick band
of fascia. The ITB runs from the lateral aspect of the pelvis to
the lateral aspect of the knee inserting on the lateral tibial condyle.
It acts to reinforce the lateral retinaculum and adds stability to the
knee. The ITB normally slides back and forth over the lateral femoral
condyle when the knee bends and extends. This intersection is the
key area of IT Band Syndrome.
athlete complains of aching pain on the lateral aspect of the knee.
They will often describe a dull aching pain a mile or two into a run
that lingers during the run but may disappear soon after stopping.
Pain is usually felt near the lateral femoral condyle sometimes extending
proximally and distally. The athlete will also complain of point
tenderness over the lateral femoral condyle.
does it happen?
has a gradual onset from overuse of the knee. This overuse causes
shortening of the ITB. It occurs most frequently in runners
with pes cavus (high arches) and genu varus (bow legs). ITB can
also occur from leg length discrepancies or muscle imbalances around
the knee. Many cases will have a history of Patellofemoral problems.
It often occurs from an increase in running distance, intensity, duration,
and/or frequency (poor training techniques). The result of these
problems is the repeated flexion and extension of the knee now causes
friction of the ITB at the femoral condyle producing inflammation and
ITB can mimic
a LCL sprain or lateral meniscal injury. Both of these injuries
usually occur suddenly from a direct force or rotation of the knee.
The athlete needs to be assessed for foot deformities. These can
cause abnormal stress to the knee contributing to overuse of the ITB.
ITB may also be associated with the following problems: hip abductor
contracture, genu varum, heel and foot pronation, tightness of the achilles,
or internal rotation of the tibia.
focused on symptom relief with the use of NSAIDs, ice, and other modalities
to control pain and inflammation. Strengthening is focused on
the hip and knee muscles to balance the forces on the knee. Stretching
of the ITB is used to decrease the stress on the knee. Transverse
friction massage and soft tissue mobilization may also be helpful.
Athletes may initially need to take some time off and should be instructed
to avoid activities that reproduce their pain. An athlete who
is not responding to rehab should be assessed for foot deformities causing
stress on the knee.
is dependent on the severity of the injury. An athlete with a
recent onset can participate as tolerated accompanied by ice after practice
and a regular rehab program. An athlete that has been experiencing
pain for a longer period of time may need to take some time off with
rehab and gradually return to activity. The athlete that
presents with foot deformities should be referred for orthotics.