ITB Syndrome

The medical explanation of this is often of a short or stiff iliotibial band, and huge amounts of time are invested in...

David Barrow

Co-Founder

Many peo­ple suf­fer from lat­er­al knee pain when exer­cis­ing and com­pet­ing in sport (1).

The med­ical expla­na­tion of this is often of a short or stiff ili­otib­ial band, and huge amounts of time are invest­ed in iso­met­rics, foam rolling, trig­ger point­ing, mas­sage or needling this struc­ture which seems so resis­tant to repair.

This arti­cle is going to present a few things that you may want to con­sid­er in addi­tion to the nor­mal old ITB treatment

First­ly, if we look at the anato­my of the ITB it’s ori­gins begin along the ili­ac crest as the glute max and TFL merge togeth­er and descend from the greater trochanter down to the lat­er­al aspect of the knee (2).

Clear­ly it can be worth invest­ing time releas­ing these mus­cles in addi­tion to an ITB stretch.

Sec­ond­ly and less known, is how the short head of the biceps femoris (lat­er­al ham­string) affects lat­er­al knee. It attach­es over the joint just pos­te­ri­or to the ITB and it’s fas­cial attach­ments blend into the ITB. You may wish to test the length, strength and feel of this mus­cle (3).

Third­ly, the ITB forms part of a strong lat­er­al fas­cial band that begins in the per­oneals of the low­er leg, through the ITB before ascends to the lat­er­al obliques, lat dor­si and beyond. Assess­ing the ROM, strength and qual­i­ty of these mus­cles would be ben­e­fi­cial to under­stand­ing how each mus­cle inter­acts with, and affects oth­er mus­cles with­in the fas­cial band (4).

These fas­cial bands are illus­trat­ed as sep­a­rate dis­tinct struc­tures in many texts such as Ida Rolf and Anato­my trains, yet in real­i­ty these fas­cial bands are inter-con­nect­ed like spi­ders webs to oth­er fas­cial bands and to oth­er struc­tures not illus­trat­ed (4).

When one con­sid­ers the per­oneals and their influ­ence on the lat­er­al fas­cial line, it might also be worth assess­ing foot type, foot fall and whether the per­son pro­pels with a high gear or low gear foot type (5). If they low gear (supinate dur­ing propul­sion) then this can cre­ate greater impact forces through the limb and increase tone along the per­oneals and lat­er­al fas­cial line straight up to the knee and ITB (5).

It can also be com­mon to hear of pro­fes­sion­als who release the lat­er­al quad as well as the ITB, after all it can be dif­fi­cult to know exact­ly when one ends and the oth­er begins (5).

You may be won­der­ing when I will men­tion the bio­me­chan­ics. Whether the per­son is quad dom­i­nant, TFL dom­i­nant, how well they run? Do they employ a heel strike, mid foot or fore foot land­ing? That my friends is a dis­cus­sion rid­dled with con­flict­ing and often very poor qual­i­ty research that flicks between dif­fer­ent par­a­digms that hap­pened to be pop­u­lar at dif­fer­ent time in our pro­fes­sion­al his­to­ry. It is also a top­ic of very detailed clin­i­cal rea­son­ing that is too long for this arti­cle. But go ahead and squab­ble as you wish!

Ref­er­ences

1. Maf­ful­li N, Wong J, Almekinders L.C. Types and epi­demi­ol­o­gy of tendinopa­thy. Clin­ics in Sports med­i­cine. 2003. 22(4): 675 – 692.

2. Ober F.R. the role of the ili­otib­ial band and fas­cia lata as a fac­tor in the cau­sa­tion of low back pain dis­abil­i­ties and sci­at­i­ca. The jour­nal of Bone and Joint Surgery. 1936 Jan. 18(1): 105 – 110.

3. Mar­shall J.L, Gir­gis F.J, Zelko R.R. The biceps femoris ten­don and its func­tion­al sig­nif­i­cance. The jour­nal of Bone and Joint Surgery. 1972 Octo­ber. 54(7): 1444 – 1450.

4. Rolf J.P. Rolf­ing: Re-estab­lish­ing the nat­ur­al align­ment and struc­tur­al inte­gra­tion of the human body for vital­i­ty and well-being. Heal­ing Arts Press. Octo­ber 1. 1979

5. Myers.T.W. Anato­my Trains: Myofas­cial Merid­i­ans for man­u­al and move­ment ther­a­pists. Sec­ond edi­tion. Churchill Liv­ing­stone, Else­vi­er. 2009.

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David Barrow

David is a Physiotherapist who has been involved in Professional Sport, battlefield trauma, chronic pain and the NHS. He continues to work clinically alongside his development role in Rehab Guru. David is passionate about Health tech to transform outcomes for patients

David Barrow

Co-Founder