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ITB friction syndrome (runner’s knee)
Iliotibial Friction Syndrome is one of the most common causes of what is often referred to as ‘Runner’s Knee’ and can account for up to a quarter of over-use injuries in runners. Being an over-use injury, it is caused by repeated trauma rather than a specific incident.
The iliotibial friction band attaches to the outer border of the tibia or shin bone. It crosses the knee and rubs on the lateral femoral epicondyle. It slides forwards and backwards across this bony point. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which commonly happens just as your foot touches the ground when running. This region of 30 degrees of knee flexion is called an ‘impingement zone’ or pinching of irritated structures over the outside of the knee, thereby producing ITB Friction Syndrome.
What is the Iliotibial Band?
The iliotibial band is a long, thin band of fibrous tissue that runs down the outside of your thigh. At the top of your thigh it is attached to your Tensor Fascia Latae (TFL) muscle and Gluteus Maximus, and at the bottom it attaches to your tibia (lower leg bone) and femoral condyle on lower outside portion of the thigh bone.
What causes ITB Syndrome?
ITB friction syndrome is caused by altered running biomechanics due to underlying muscular imbalances. Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.
The most common causes:
- Poor biomechanics (running technique); particularly inwards rolling knees and hips
- Weak hip / gluteal muscles
- Weak hip rotators
- Weak inner quadriceps
- Weak core muscles
- Poor foot arch control
- Worn out or unsuitable trainers
- Sudden increase in mileage for training
- Excessive hill training (particularly downhill)
- Endurance running (training for ½. and full marathons, ultra-marathons)
The most common symptom includes, sharp or burning pain just above the outer part of the knee; pain that worsens with continuance of running or other repetitive activities; swelling over the outside of the knee; pain during early knee bending; gradual onset of symptoms which if they persist for greater than 4 weeks can cause major interference for any sport or activity.
How is it treated?
The mainstay for treatment is physiotherapy and podiatry which will address muscle tightness and balance. A steroid injection can speed recovery. Surgery is almost never required.