Iliotibial band syndrome (ITBS) is a common repetitive strain injury of the Iliotibial band.
ITB Syndrome mostly occurs in runners, but can also occur in cyclists, hikers and as a non sporting injury. ITB Syndrome causes pain mainly on the lateral (outside) side of the knee, unlike patellofemoral pain where the pain occurs at the front of the knee.
Although ITB syndrome is very common, ITBS remains neglected by studies and so remains mostly unexplained adding the persistence of many myths.
Heres the Anatomy
The iliotibial band (ITB) is the largest Tendon in the body acting as a longitudinal fibrous reinforcement of the Tensor Fascia Latae muscle and Gluteus Maximus muscle. The action of the ITB and its associated muscles is to extend (take the leg backwards), abduct (take the leg outwards), and laterally (externally) rotate the hip. In addition, the ITB contributes to lateral (outside) knee stabilisation.
Tendons connect our muscles to our bones and each muscle has tendons that attach at each end. Tendons are NOT designed to stretch as they are comprised of highly organised connective tissue and are capable of resisting high tensile forces while transmitting forces from muscle to bone. Tendons are predominately made up of collagen (nearly 85% of the dry weight of tendon) which mechanical and physiological characteristics dictate the qualities of a tendon. Tendons are flexible in terms of being able to bend at joints and act as a damping tissue to absorb shock and limit potential damage to muscle.
Basic Characteristics of a Tendon
- Tendons attach Muscle to Bone
- Tendons have one of the highest tensile strengths found among all soft tissues
- Tendons are made up primarily of collagenous fibres making them remarkably strong
- Tendons have a very limited bloody supply making them slow to heal
Basically Tendons are tough, they are not designed to stretch or contract. Muscles do the stretching and contracting. It is muscles that become shortened (tight) which can create further forces through a tendon, but tendons do not stretch therefore the joint the tendon acts upon to proximate (pull together) the joint will become restricted or misaligned therefore causing pain.
So how do I relieve the Pain
A couple of the most common methods are Form Rolling or Massaging the ITB.
Now STOP, why do we want to foam roll or massage the ITB?
We cannot increase its blood flow nor can we increase its length, its a tendon not a muscle!
So… if you want to effect the ITB you need to work on the associated muscles which are the Tensor Fascia Latae muscle (TFL) and Gluteus Maximus muscle.
Massage is a great way of releasing tension and will often be more effective than foam rolling because as a patient you can relax and let the therapist do all the work. However, foam rolling is a very good method of loosening muscle tension. Here are a couple of videos showing you how to foam roll the Tensor Fascia Latae muscle and Gluteus Maximus muscle.
TFL Foam rolling; https://youtu.be/E2CmI2nIchE
Glutes Maximus; https://youtu.be/hte5i_qa6UY
Glutes Maximus; https://youtu.be/lXGnSJ63_vM
Written by Becky Tyler 26th Feb 2019
Kirkendall, D,T., Garrett W,E., ‘Function and biomechanics of tendons.’ Scand J Med Sci Sports. 1997 Apr;7(2):62-6. Available at; https://www.ncbi.nlm.nih.gov/pubmed/9211605 (Accessed: 26 February 2019)
Ingraham, P., “Save Yourself from IT Band Syndrome!” Available at: https://www.painscience.com/tutorials/iliotibial-band-syndrome.php (Accessed: 26 February 2019)
Newell,L., “A Description of Tendons, Ligaments and Muscles” Available at: https://www.livestrong.com/article/125439-description-tendons-ligaments-muscles/ (Accessed: 26 February 2019)