Iliotibial (IT) Band Syndrome: Symptoms, Causes, Healing Cycle & Treatment

What is Iliotibial (IT) band?

An Iliotibial (IT) band, also called a Maissiat tendon, is a long connective tissue or fascia that extends from the thigh to the knee and tibia along the outside of the leg. The IT band stretches, compresses, and rotates the hips, stabilizing the lateral movements of the knee while protecting the outside of the thigh [1].

What is IT Band Syndrome?

IT band syndrome is a common lateral knee injury that is caused by excessive and repetitive flexion and extension of the knee joint. This happens when the IT band becomes tight, sore, or inflamed due to the increased tension in the band causing greater friction on the outside of the knee during flexion, which can be painful [1].

Symptoms of IT Band Syndrome

1. Lateral knee pain is the most common symptom of IT band syndrome. This is caused by inflammation of the area where the IT band goes back and forth in the epicondyle of the femur [2].
2. Due to the slight pain in the initial phase, some patients may experience a popping sound in their knees and there may be swelling where the bandage passes through the lower jaw or where the lower knee connects to the tibia. There may be an aching, tingling, or needle-like sensation at first but often overlooked. This popping and tingling sound may be felt whenever the heel touches the ground, it gradually develops into severe pain and eventually becomes chronic pain when walking or climbing stairs [1, 2].
3. Sometimes the pain can spread along the path of the IT band to the outside of the thigh to the buttocks that can cause knee stiffness characterized by stiffness or tightness in the knee muscles [1].

Causes of IT band syndrome

1. ITBS is caused by excessive tension on the IT belt and excessive friction caused by friction against the bone during running, which is characterized by the overuse of the knee joint and repetitive exercises. When the knee is moved during running, the IT band causes friction, irritation, and pain [3, 4].
2. Tightness or stiffness in the IT band due to prolonged standing walking or running can cause IT band syndrome.
3. Some people have imbalanced muscles involved in the knee joint due to which the pressure at the IT band is increased leading to the IT band syndrome [5].
4. Bowlegged people are at higher risk of developing IT band syndrome because the legs are deformed at an inward slope that increases the pressure at the IT band [4, 5].
5. Knee arthritis is another cause of the IT band in which the knee joint is impaired due to the weakened femur and tibia resulting in the tightness and stiffness in the IT band that causes IT band syndrome [3, 4]
6. Leg length discrepancy refers to the uneven length of the femur or tibia bones due to which the length of both the legs is different. As a result, there is increased pressure in the IT band of the leg that is shorter in length causing the IT band syndrome.
7. Just like muscular imbalance, weak knee or hip muscles also contributes to IT band syndrome. According to Ding et al. people having weak glutes or hip muscles tend to have IT band syndrome [5].

Healing Cycle Involved in IT Band Syndrome

A normal healing cycle that occurs inside the body to heal the IT band syndrome pain consists of the three stages namely, inflammation, proliferation, and maturation.

The first inflammation stage is started by the increased temperature, redness, and swelling at the lateral side of the IT band resulting in calling out the white blood cells to start the proliferation stage [6].

The next stage of proliferation releases the scar tissue at the site of the IT band which is a fibrous and stretchable connective tissue that covers the IT band at the inflamed site. This leads to the release of a trigger point at which the fascia release is started. Fascia is a muscular tissue that is released at the scar tissue so that the inflamed site can be healed. There are two layers of fascia including superficial and deep layers where the deep layer is further divided into four layers of aponeurotic fascia, epimysial fascia, perimysial fascia, and endomysial fascia. These deeper layers contribute to healing the inflamed site of the IT band so that it can reach the maturation stage [6].

In the maturation stage, the scar tissue is removed from the site and the fascia becomes smooth and matured so that the healing process can be completed. However, in chronic pain, the maturation stage is not reached because of the continuous release of fascia, trigger point, and scar tissue sensing the continuous inflammation at the injured site of the IT band [5, 6].

Non-Effective Treatments

People perceive that heating, icing, massaging, electronic stimulation (Estim), and foam rollers can help in relieving the IT band syndrome pain but it is not the case as these techniques can only provide temporary relief but cannot be considered as effective long-term treatment of IT band syndrome. Similarly, joint mobilization, stretching, and strengthening exercises are also not effective in treating IT band pain because they can increase the severity of the pain due to increased muscular activity, increased extension, and flexion at the knee joint [5].

Effective Treatments for IT Band Syndrome

Inflammation Stage 

• During the inflammation stage, rest is the most effective therapy as only reduced joint activity, lesser extension, and flexion at the knee joint help in relieving IT band syndrome pain.
• Magna Heal is a wearable device that is comprised of a small magnet that provides alignment in the knee muscles, tendons, and ligaments hence effectively helping in treating IT band syndrome.
• An anti-inflammatory diet and supplements to restore deficiencies can also help in reducing inflammation in the IT band [5].

Proliferation Stage 

During proliferation stage it is needed to release the scar tissue and fascia externally through external pressure application. Therefore, the use of A3 to apply pressure at the superficial layers of scar tissue, and A5 for the deep layers of scar tissue is effective to release scar tissue formed at the injured site of the IT band. Similarly, the use of A1 to apply pressure at the superficial layer of fascia and A5 for the deeper layers of fascia (epimysium, perimysium, and endomysium) is effective to release fascia in the IT band [7].

Summary

It is important to take the IT band syndrome pain seriously and seek ways through which it can be treated externally, therefore contact us for detailed information and guide regarding IT band syndrome.

References 

1. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Dec 1;19(12):728-36.
2. Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Physical Medicine and Rehabilitation Clinics. 2016 Feb 1;27(1):53-77.
3. Hadeed A, Tapscott DC. Iliotibial band friction syndrome.2019.
4. Van der Worp MP, van der Horst N, de Wijer A, Backx FJ, Nijhuis-van der Sanden MW. Iliotibial band syndrome in runners. Sports medicine. 2012 Nov;42(11):969-92.
5. Ding GY, Shi SY, Ling XY, Yuan JJ, Zhang Z, Luo C, Xiao LW, Tong PJ. Clinical diagnosis and treatment for iliotibial band syndrome. Zhongguo gu shang= China journal of orthopaedics and traumatology. 2018 Oct 1;31(10):965-70.
6. Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. Journal of Sports Medicine. 2013 Oct 2;2013.
7. Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Medicine. 2005 May;35(5):451-9.