Iliotibial Band Pain

Athletes commonly complain of pain on the outside of the knee, known as lateral knee pain, and pain from the iliotibial band is one of the most common causes of this problem in athletic performers. Inflammation of the lubricating sac around the structure known as the iliotibial band is the cause of this condition. Repetitive movement of the structures on the outside of the thigh is a strong cause of this condition so the most common activities which provoke this syndrome are running and cycling. The iliotibial band is a narrowing of the wide collagen band known as the fascia lata which originates from the gluteal muscles and passes down the outside of the thigh to insert into the top of the shin bone.

Overall this ligamentous type structure stabilises the outside of the knee and assists with knee and hip movements. As the knee moves back and forth into bend and straighten the band may impinge against the side of the condyle of the femur, the expanded lower end of the thigh bone. This is suggested to be a potential cause of the pain, with the local bursa becoming inflamed. When running the maximum friction may occur around 30 degrees of knee bend just after the foot strikes the ground, with running downhill and running slowly being more aggravating.

Patients report pain on the outside of the knee whilst running which will normally settle after the exercise has stopped but if the aggravating activity is persisted with the pain can persists in between exercise sessions or occur in walking. The pain is usually in a fairly precise location about an inch above the knee joint line on the outside of the knee, while it may radiate if it become worse, either upwards or downwards.

Physiotherapy for the acute condition includes ultrasound, cold therapy such as ice and resting from the aggravating activity. The physio will teach the patient how to stretch out the iliotibial band along with the other local muscle groups such as the buttock, hip adductor and hamstring muscles. This targets the acute inflammatory process and restricts repetition of the activity responsible for the syndrome. The physio may suggest alternative ways of keeping fit without bringing on the pain, and examine the footwear of running athletes for functional foot and lower leg abnormalities. Orthotics may be prescribed to correct abnormal foot posture in running which is very common. Once settled the patient can start strengthening exercises around the hip and stretching over time.