Runner’s Knee (Iliotibial Band Syndrome)
The knee is a common site of pain and injuries in sportspersons because of its involvement in all kinds of sports. Many factors can cause knee pain, with runner’s knee or iliotibial band syndrome being one of the commonest.
Iliotibial band syndrome (ITBS) is an overuse injury characterised by pain on the outer side of the knee, caused by constant friction of the iliotibial band at the lower end of the thigh bone (near the outer aspect of the knee joint). It is common in long-distance runners, cyclists and other athletes, as well as military personnel.
The iliotibial band/tract is a thick band of fascia (a tissue that surrounds the muscles); it runs from the outside of the hip down to the knee. At its upper end it is attached to the Tensor Fasica Lata muscle in the front and the gluteus muscle at the back. From here it travels down on the outer side of the thigh, inserting at its lower end into the kneecap (patella) and the shin-bone (tibia).
Mechanism of injury:
The ITB is a very strong tissue that stabilises the knee in the extended as well as in the partially flexed position. When the knee is bent, the band shifts behind the femoral epicondyle (prominence at the lower end of the femur) and when the knee is extended, the band is again pulled forward in front of the epicondyle. A small fluid-filled sac (bursa) is interposed between the band and the femur to reduce friction; however repeated knee stretching and bending irritates the adjacent structures, leading to inflammation of the bursa, the band and the bone as well.
Iliotibial band friction syndrome or ITBS is caused by functional overload. Factors that lead to ITBS include:
Physical findings are enough to reach a diagnosis. X-rays may be taken to rule out any bone fractures or outgrowths. In severe cases, MRI is helpful in defining the extent of damage. It shows a thickening of the band (at the site of friction) along with fluid accumulation.
A comprehensive rehabilitation program should be devised to:
Start with mild stretching. Stop if it hurts. Hold the stretch for a few seconds, or more if it stays pain free. Repeat 3 to 4 times daily.
A warm band stretches better, use a heat pad or take a warm shower before stretching.
Once movement is pain free, commence muscle strengthening exercises focusing on the:
Sports massage improves circulation and helps to release excess tension in the band. It is recommended on a regular basis, the frequency depends on the person’s activity level.Surgery for ITBS includes:
Surgery is not usually required as symptoms usually improve with proper rehabilitation.