Iliotibial Band Friction Syndrome

What is iliotibial band (ITB) friction syndrome (runner’s knee)?

Iliotibial band friction syndrome (ITBFS), also known as runner’s knee, causes pain on the outside of the knee when running and going downstairs. ITBFS causes an achy pain, but on occasion, it can be quite a sharp pain. The pain often increases over several miles and then builds to a point where you have to stop running. A diagnostic ultrasound scan is the gold standard imaging test to discover if your pain is coming from iliotibial band (ITB) friction syndrome. At Complete we do this at no extra cost at your first appointment.

Reducing your running mileage, changing your running trainers and/or technique alongside a structured course of physiotherapy will resolve this issue in the majority of cases. Physiotherapy is likely to involve a running assessment and rehabilitation exercises to strengthen your core, and muscles surrounding the hip and knee. Hands on (manual) therapy may also be carried out if you have specific areas of muscular tightness and/or joint stiffness.

If your pain does not improve with a course of physiotherapy, an ultrasound guided steroid injection can reduce the inflammation from the repetitive ‘rubbing’ of the ITB over the lateral femoral condyle (the bony bit on the outside of the knee). Using ultrasound guidance allows the exact location of the pain to be targeted.

What are the symptoms of iliotibial band (ITB) friction syndrome?

The symptoms of iliotibial band (ITB) friction syndrome are:

Sharp pain on the outside of the knee with running and going downstairs

Pain is most commonly felt when the foot strikes the ground and might persist after activity

Tenderness on the bone on the outside of the knee when you press it

If this sounds like your pain, read on below…

What other conditions can mimic iliotibial band (ITB) friction syndrome?

If this does not sound like your pain there are other conditions that can mimic the pain of iliotibial band (ITB) friction syndrome, such as:

Iliotibial band (ITB) friction syndrome vs Patellofemoral (knee cap) joint (PFJ) pain

Iliotibial band (ITB) friction syndrome causes localised pain on the outside of the knee which can quite often be quite ‘sharp’. Whereas, patellofemoral joint pain causes more diffuse pain on the anterior (front) of the knee and is often more of an ‘achy’ pain.

Both ITB friction syndrome and patellofemoral joint pain are aggravated by running, particularly downhill, and walking downstairs and are often not associated with significant swelling. However, patellofemoral joint pain is more associated with clicking (known as ‘crepitus’) at the front of the knee compared with ITB friction syndrome. ITB friction syndrome is not aggravated by lunging and squatting, whereas the pain associated with patellofemoral knee joint pain often increases with these movements.

What is ITB syndrome, and how do you get it?

Iliotibial band friction syndrome (ITB syndrome) can respond very well to ultrasound-guided steroid injection. Many marathon and long distance runners will experience ITB syndrome at some time in their training. The problem often coincides with high volumes of training mileage and therefore is oftentimes experienced when training is tapered upward in preparation for long distance events such as marathons, half marathons and Iron Man. This is a problem that is also common amongst cyclists.

ITB syndrome refers to irritation of the iliotibial tract as it passes over the lateral epicondyle (outside) of the distal femur (thigh bone). First-line treatments should include a full assessment and biomechanical analysis relating to pelvis, hips, knees and ankle during their main aggravating activity – usually either running or cycling. Identification of specific muscle weaknesses or restriction of joint or soft tissue mobility can be addressed through physiotherapy (therapeutic exercise, tissue manipulation and rehabilitation). However, even when such aggravating factors have been addressed patients may still continue to experience some degree of pain. Also, in reality patients may not have the time left prior to their event to fully address all of these mechanical factors as these can take time to resolve.

This is where an ultrasound guided injection of steroid can have an important role in quickly reducing the patient’s symptoms and allowing them to continue with their training and that all important race!

Steroid injections can take 3-5 days to exert there affect therefore if considering a steroid injection to get you through a specific event we recommend is having the injection ideally not less than 5 days before to maximise the chances of it working in time.

The injection itself is quite superficial and therefore does not enter into the knee joint nor does it go directly around any tendons therefore it is usually considered safe to begin running again after 24-48 hours post injection.

Our expert clinicians will normally provide a full musculoskeletal and functional assessment as well as an ultrasound scan of evaluation to help decide if a steroid injection is appropriate. Patient’s will be screened for potential contraindications and advised of potential risks and precautions prior to the injection.

Related conditions, blogs and patient’s stories from our specialists

Our highly experienced team of expert clinicians have written a selection of blogs on various treatment methods for ITB syndrome, some stories from patients that came to us seeking relief from their knee pain, as well as explanations of other knee conditions that might be causing your pain. Please take a look at any of the following links and get in touch with us if you think you are suffering from any of these conditions and may require treatment.