Knee Pain and Physical Therapy: Understanding Iliotibial Band Syndrome

Ryan LaCorte Maria Kaminski, Publications

Do you experience knee pain while shopping, climbing stairs or running? Iliotibial Band Syndrome (ITBS) is widely accepted as the most common running injury and accounts for 22% of knee injuries.

ITBS involves pain on the outside part the knee and occurs following repetitive activities such as walking, running, or cycling. The iliotibial band is a thick band of tissue on the outside of the upper leg, originating in the pelvis and extending over the hip and inserting just below the knee joint. When aggravated ITBS can be extremely painful and frustrating to cope with, often preventing many active adults from performing their favorite exercise activities.

What Causes My Knee To Hurt?

The concept of ITBS occurs during activities of repetitive knee bending (i.e. running and cycling), where the iliotibial band is repetitively shifted forward and backwards over a bony prominence of the knee, also known as the lateral femoral condyle. This repetitive shifting causes friction and thickening of the iliotibial band initiating localized inflammation, swelling and pain. Pain associated with ITBS can be described as a sharp, burning or stinging pain just above the knee joint with swelling following activities such as climbing stairs, shopping or running. Although most people experience pain with activities, symptoms may not occur immediately during the activity and can become more intense as the activity continues.

What Makes Me More Susceptible To Injury?

There are many factors that contribute to ITBS including your training regimen, muscular imbalances, poor muscular flexibility, and wearing improper footwear while performing everyday activities or while exercising.

  • Overuse injury: Typically, ITBS is brought on from advancing your training regimen too quickly. Whether you are adhering to your New Year’s resolution or training for a 5K, you always want to gradually increase the intensity of your workout and avoid repetitive exercises. Vary your training routine by incorporating cross-training techniques by attending aerobic classes, walking, and swimming.
  • Weak Hip Musculature: Researches have explored the relationship between hip weakness and ITBS and found a positive correlation exists. Weak muscles in the hip tend to lead to deviations in your gait increasing tension on the knee joint and leading to iliotibial band tightness.
  • Decreased Flexibility: Tightness in the iliotibial band and surrounding muscles of the leg can contribute to knee pain. The iliotibial band connects the muscles in the front of the leg to the muscles in the back of leg. Tightness in any of the surrounding musculature can contribute to knee pain. In addition, increased tightness of the iliotibial band, through its attachment to the knee cap, can cause the knee cap to shift laterally causing additional pain.
  • Proper Footwear: You always want to make sure you are wearing supportive footwear with adequate arch support. If you are wearing old shoes or shoes that do not provide proper arch support, you will experience decreased ankle stability and exert additional stress on the knee joint.

How Can Physical Therapy Help Me and What to Expect?

Physical therapy can benefit those who are experiencing knee pain through treatments consisting of activity modification, stretching, strengthening, and education. A full physical examination will be conducted by the physical therapist to determine your cause of knee pain. The initial goal of physical therapy is to reduce the inflammatory phase focusing on educating the client on activity limitation and pain relief through modalities such as ultrasound therapy and ice massage. In addition to modalities, an individualized stretching and strengthening program will be designed to increase flexibility and strengthen the lower extremity muscles. If your symptoms occur while running, the physical therapist will assess your running form and diagnose any abnormalities. During this time the client will also be provided with a home exercise program and gradually return to activity as symptoms decrease.

Prevention of ITBS

  • Decrease your activity level or running mileage if you experience pain on the outside of your knee.
  • Perform a warm up prior to exercising and a cool down following exercising.
  • Examine your shoes for unusual wearing patterns on the outer edges. If your soles are worn down, think about replacing your shoes.
  • Avoid running uphill and downhill.

What Can I Do Now To Help My Pain?

If you are experiencing symptoms you should stop performing any exercises that exacerbate your symptoms. You should ice your knee 2-3 times per day ranging from 10-15 minutes. If symptoms persist with visible swelling and pain while walking or performing activities, follow up with your physician.

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