ANATOMY

 

The iliotibial band (or tract) is a thick band of tissue that starts on the pelvis and upper thigh and passes along the outside of the knee and attaches to the outer tibia. When the knee moves the iliotibial band slides over a bony prominence on the outer knee (lateral femoral epicondyle).  Iliotibial band friction syndrome or iliotibial band tendinitis is a painful condition on the outer (lateral) aspect of the knee that is common in long distance runners.

 

INJURY

 

The iliotibial band friction syndrome is an overuse injury caused by repetitive friction of the iliotibial band crossing the lateral femoral epicondyle. It is a well recognized cause of knee pain in runners, so it is commonly called "runner's knee”. It is can also occur in other athletes.

 

The average jogger strikes the foot against the ground 3,000 times per mile. This adds up to 60,000 foot impacts for every twenty miles. While running you only have one foot on the ground at a time. When walking, 30 percent of the time, both feet are on the ground. When running, the force of landing has been estimated to be about three times your body weight. This means that if you weigh 150 pounds, the force in your leg when you land is around 450 pounds. Shoe mileage should also be considered. After 500 miles most shoes retain less than 60% of their initial shock absorption capacity.

 

When cycling, with each pedaling stroke, the iliotibial band slides over the lateral femoral epicondyle. Knee flexion and extension occur approximately 4800 times an hour (at an average cadence of 80 revolutions per minute), so the iliotibial band is susceptible to repetitive irritation.

 

Treatment

 

The injury is the result of too much running.  In the simplest terms, if you stop running, the injury will eventually heal.  There are ways, however to continue to run if you modify your training schedule and technique.

 

Initial treatment has two objectives: to reduce the inflammation and to allow the iliotibial band to heal. When the knee is painful and swollen, you must rest it.  Avoid activities that aggravate the pain.  Reduce your activity to a pain free level.  Keep your knee straight while sitting, and avoid repetitive squatting.  Let pain be your guide.  Mild discomfort or ache is not a problem but do not do activities that cause definite pain.

 

Ice your knee for 20 minutes, two or three times a day and after any sporting activities—apply a bag of crushed ice over a towel.  This reduces swelling, inflammation and pain.

Aspirin, Aleve or Advil sometimes helps to relieve pain and reduce inflammation.

 

A physical therapist or Dr. Gill can recommend exercises to strengthen the muscles.  Exercises can also be used to stretch and balance the thigh muscles.   In rare cases surgery may be indicated.

 

Sports

 

Use your judgement.  When your knees hurt, avoid sports that may aggravate your knee problems.  Total elimination of running may be required for a while.  When your knee is better, you should be able to return to most sports.

 

Sports that aggravate iliotibial band syndrome:  distance running, cycling, volleyball, basketball, soccer, racquetball, squash, football, weightlifting (squats).

 

Sports that may or may not cause symptoms:  baseball, hockey, skiing and tennis.

 

Sports that are easiest on the knees:  Swimming (especially with a flutter kick), walking (avoid up and down hills), and cross-country skiing.

 

Although many sports can cause or aggravate the iliotibial band, running is the main culprit.  It is better to vary your running schedule and use interval training:  run sprints three days a week, intermediate distance two days a week and long distance once a week.