Illiotibial Band Syndrome (ITBs)

Illiotibial Band (ITB)

Where Is It?

The ITB runs along the lateral aspect of the femur from the hip to the outside of the knee. 

What Is It?

It is a long fibrous band that helps stabilisation of the muscles and bone while in activity.

So now that you know where it is and what it does, I'm going to talk a little bit about why it gets tight or injured, and how come its a reoccurring problem. 

What I have found is that people who are highly susceptible to having ITBS (the S is for syndrome) are; 

Over Pronators 

Glute weakness

Hip flexor shortness (people who sit down for most of the day)

Women (due to a wider pelvis)

Weak VMO (vastus medialus oblique. The tear drop shape muscle on the inside and above the knee)

People with bunions

(Notice the collapse of his knee and creating a problem with his foot. His foot isn't hugely effected, but because running is a repetitive action, it can cause problems down the line)

Most of the above are found in conjunction with one another when having ITB problems. 

Let me explain why each point above contributes to problems in the area.

The ITB is basically a tendon of the TFL muscle (Tensor Facia Lata). The function of the TFL is to flex the hip and also plays a role in internal rotation of the femur. This means it helps twist the femur so your knees are facing one another.

When the TFL gets tight, along with the other hip flexor muscles, it creates too much inward twist, leaving the leg to collapse at the knee when landing. When this occurs, it forces the foot to over pronate. Finally, when the foot over pronates over a long period of time, a bunion can form because of the amount of torsion being put on the medial muscles and bones of the foot. When this happens it over works the ITB which tightens the band. When the band gets tight, the band will rub over a boney prominent when the leg bends at 30 degrees, which then makes the attachment inflamed.

Now days, humans tend to sit down for the majority of the day. Because of this, our hip flexors get shortened (not tight. That's something I will talk about later) and our gluteus get stretched. Meaning, the glute cant do its action correctly when running, which is to externally rotate then femur and extend the hip. This leads to too big of a differentiation between the two opposing muscle groups. Resulting in an inward rotation of the femur like I said earlier. This is one of the reasons why ITBs is one of the main injuries I see at the clinic.

There needs to be a balance between the hip flexors/internal rotators and the gluteus for the leg to land and take off efficiently. 

A way to test at home is to carry out follow exercise. 

Lunge forward. Notice if the lead leg wants to be pulled medially inwards. 

A) good

B) bad

In the next picture, you will see a runner who has problems with his ITB and his knee. The tendons have become tight and inflamed, which has caused a clicking noise as he flexes his leg. This is due to the repetitive action of running incorrectly.

As you can see his knee collapses as he lands, his foot over pronates, and when he takes off his leg wants to flick out which is a clever way for the body to compensate for its opposing differentiations. 

So. Is it correct footwear or fixing the muscles? I think both. You need to fix the underlying problem that causes the inefficiency. 

1) lengthen the hip flexors. 

2) strengthen the gluteus 

3) work on the flexibility of the ITB

4) get the balance of strength from opposing muscle 

I won't give out strengthen exercises for this as its a complex injury. If you start doing exercises that isn't individualised to you, you might be causing more of a problem rather then fixing it.

My main advice would be to not do too much too soon. This will heighten any inefficiency/underlying problem.