Iliotibial Band Syndrome
What is It?
“ You cannot stretch it, or foam roller it better, and orthotics wont help you”
Iliotibial band syndrome is the most common cause of lateral knee pain in runners. It is often imagined that the ‘band’ passes from hip to knee and gets ‘tight’ and needs stretching, but in fact this band is affixed the whole way down the leg an cannot be massaged, rubbed , needled or released. The Pain comes from compression of a nerve bundle filled fat pad underneath the fascia as you can see in the diagram – but the underlying cause of this condition is usually the way you run.
There are many reasons why this might be affected in the amount of time you spend in contact with the ground:
Crossing Over of feet
It is not your shoes, or orthotics or feet!
We start by a full clinical examination to rule out other causes such as meniscus
injury or anterior knee joint damage – occasionally we may require an MRI scan of your knee but it is usually not essential. We then need to look at you run. We do this on a video treadmill – where two views of your running technique are taken and we look at those – not to see if you are perfect ,but to identify if you have several features of running style which cause the fat pad to be loaded
Usually we see 3 common faults
1. Cross over Gait
You run like a catwalk model with your legs angled inwards and with one foot in front of the other
2. Hip Drop
In part caused by number 1 your hip that is not in contact with the leg in stance phase, drops, allowing the load on the stance leg to increase in rotation
3. Ground contact time
By allowing the foot to remain in contact wit the ground too long, the knee is allowed to flex more than it needs, adding to the fat pad irritation
What is the solution??
We occasionally use local anaesthetic to confirm the diagnosis into the fat pad, but start to change the way you run immediately to offload the stressors. It is not an instant paint on fix, you need to do some work in strength and retraining but we are confident in our results