ITB Friction syndrome (aka. Runner’s Knee)

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By Physiotherapist, Katharina Schaps

One of the most common injuries we see in the active patient is ITB friction syndrome (ITBFS). Although it is more commonly seen in Runner’s, ITBFS can appear with any type of sport involving repetitive bending of the knee such as hopping, stair climbing or hill walking.

How do I know it’s ITBFS?

The pain you experience is a fairly sharp sensation over the outside edge of the knee when bending the knee under load. For example, when squatting down to the ground or walking down stairs. You may be able to find a localised and possibly swollen tender spot through the outer knee. With running, the pain usually gets progressively worse with each stride and worsens the longer you run. Depending on the degree of irritation there may be a residual ache after activity. Symptoms usually first occur when there has been a change in activity levels, this may be in the form of a longer run than usual or a hiking trip that turned out to be more hilly than expected.

What is the ITB and how does it result in being painful?itb

The ITB is not a muscle, although it shares myofascial connections with the hip muscles such as the gluteals, Tensor Fascia Lata (TFL) and the outer Quadriceps muscle. It is a thick fibrous band which runs from the outer hip along the outside thigh and attaches into the upper shin bone. The ITB is responsible for stabilising the hip and knee sideways, ie. it prevents us from dropping to the side when standing on one leg. The pain in ITBFS stems from a small but sensitive fat pad which sits just under the ITB near its insertion into the shin bone. The irritation occurs when there is excessive pressure through this portion of the ITB, usually related to excessive ITB tension. The fat pad is being wedged against the femoral condyle (a small bony prominence over the outer knee) and becomes inflamed if repeatedly irritated. It is thought that the ITB is over tensioned due to an over-use pattern of the TFL and under-use or weakness of the hip abductors/extensors, such as gluteus medius/minimus and to a lesser extend the gluteus maximus.

How is ITBFS treated and what can I do to help it recover?

What the physio/therapist does:
Sports massage: Massaging through tight muscles and myofascia can help to reduce the tension through the ITB.
Dry needling (Acupuncture): Using needles helps to reduce tension along myofascial connections by targeting muscles knots called ‘trigger points’. There are several complex local and neurophysiological responses which lead to a relaxation of these trigger points when using dry needling.
Taping: Kinesiology tape is often used to change muscle activity and myofascial tension through the side of the knee.
Stretches/Mobility training: Regular stretches and mobility exercises through the hip and knee muscles help to ease muscle tension, done either within a treatment session and/or as a regular home exercise.
Strength/stability/movement exercises: Strength and stability exercise of the gluteal muscles address the muscle imbalance and overuse of the TFL muscle. This often takes several weeks to show effects since muscle re-training happens only gradually over 4-6 weeks. Compliance with the right and regular physio exercises is therefore vital in long-term changes to ITB problems.

What can I do at home?
Ice: Icing 2x daily for about 15-20mins will help to reduce inflammation and pain.
Relative rest: Avoid continuing what aggravated it in the first place (eg. running, walking etc).
Foam rolling: The foam roller has become one of the most important tools for managing injuries. It is essential to complement regular sports massage since it is a form of self soft-tissue release work. It targets the ITB, gluteal muscles, TFL and quadriceps muscle to loosen and reduce tension on the ITB and ultimately reduce the strain on the irritated fat pad.
Tennis ball/Massage ball: Using a foam roller for the TFL muscle is often tricky since it’s a relatively small muscle. Using a tennis/massage ball is often a lot easier by lying on your side and placing the ball between the pelvis and the floor.

How can I prevent it?

The best prevention is to train smart. If you are a runner, only increase your mileage by about 10% per week. If you are a novice runner give yourself several weeks/months to get into running and start with walk/jogs or very short distance runs.
See my previous article on avoiding a running injury.

ITBFS can often be a recurrent problem, especially when there is a significant muscle imbalance through the hip muscles. However, it is very much a treatable condition and most patients recover quickly with the right management and when treated as soon as symptoms occur. If you have ITBFS symptoms try to avoid aggravating it further by continuing running or sports. If your pain does not settle despite having rested it, or if you are unable to rest it come and see one of our physiotherapists for a thorough assessment.

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