How to treat ITB effectively
Are you a cyclist or a runner experiencing PAIN at the outside of your knee or hip? If so, there is a very high chance it could be a condition called Iliotibial Band Syndrome (ITB).
Iliotibial Band Syndrome (ITB) presents as a sharp pain at the outside of your knee or hip, often worse when running down inclines or when the knee is bent at a 30 degree angle. It is a very common condition in runners and cyclists due to the repetitive bending & straightening of the knee in a poor position – either due to suboptimal bike setup or weak muscles. This is a very common sports injury that we treat at Cape Town Physiotherapy with great results.
Outdated theories of the cause of ITB pain included the notion that the ITB rubbed against the outside of the knee thus causing inflammation and pain. This is no longer the case as more recent research acknowledges that the ITB becomes painful due to tensile loading or being stretched due to poor biomechanics or alignment.
So what does this mean?
If you are a cyclist, poor positioning of your cleats or saddle, even by a fraction, can put a strain on the ITB causing pain.
In runners, weak gluteals or buttock muscles, cause the hip and knee to adduct or fall inwards, putting a tensile strain on the ITB thus causing pain.
What does this mean for treating ITB effectively?
Simply having a sports massage, dry needling, foam rolling or stretching without treating the underlying biomechanical cause will be ineffective. Likewise, resting from sport will only keep you pain-free while you are ‘resting’! While these techniques may be helpful, unless you fix the underlying weakness, the pain is likely to return when you return to your sport.
Take a look at the picture of the anatomy of the ITB below, and note how it runs the length of your hip and knee and has multiple muscles attaching to it. Muscle weakness causing increased angles at your hip and knee are the major causes of ITB pain.
In summary, the cause of ITB are most commonly:
- Biomechanics: how your hip, knee and ankle are moving
- Footwear for running, bike setup for cycling
- Hip or buttock weakness
- Overuse and tightness
What can you do?
- Correct footwear. Replace old shoes!
Correct bike set up.
- Increasing stability at your hip reduces strain at your knee and ITB. Strong glutes are key!
- Myofascial release of tight muscles and fascia. You can do this by self-rolling (make sure you have the right technique that targets the glutes, tensor fasciae lata and quads) stretching and/or seeing a physiotherapist for hands-on treatment but most importantly rehabilitation: strengthening of the RIGHT weak muscles and stretching of the RIGHT tight muscles.
Thus improving how you move.
During your first physiotherapy session at Cape Town Physiotherapy we perform specific tests to clarify which muscles are tight and need release (via stretching, rolling, needling, massage) and which muscles are weak and need strengthening. We are all individuals with different imbalances and so a one-size-fits-all ITB programme doesn’t always work. But seeing a physiotherapist experienced in this field can.
If your ITB symptoms are recent, you may only need one physio session to get you up and running with an individualized rehab programme targeting your imbalances. If your ITB pain has been around for a few months you may benefit from one or two hands on physio treatments (which can include massage, myofascial release, dry needling, foam rolling) alongside a strengthening and stretching home exercise programme.
Our goal is to get you back to what you love as fast and effectively as possible.