Iliotibial Band Syndrome – runner’s knee (or, in my case, hiker’s knee)
Over the past couple of months, I’ve noticed many clients who’ve had tight iliotibial bands (ITB’s). They’ve usually come to see me for other reasons – like shin splints or back aches. While only a few of them have presented with signs of knee pain, it had me remembering my time suffering the excruciating and debilitating knee pain from iliotibial band syndrome.
My iliotibial band syndrome pain happened before my Bowen days. If only I understood then what I know now, the recovery time may have been shorter – despite 3 physical therapists and 2 podiatrists, before my local Bowen therapist and personal trainer.
About 6 years ago, some friends and I decided to hike Mount Kilimanjaro. Truth be told, somehow I got the idea in my head and dragged my friends into it – if I train and am fit, then I can do it.
I had decided to start heading to my hilly area out of town on weekends, the trails that I had trained on in the past. I wasn’t too unfit at the time, but living in a flat city I needed hills to help legs get stronger. After a couple of walks, I also added some extra weight in my pack to help push me a little, a few extra bottles of water.
I remember when it hit. After one training hike, I was walking down the stairs to catch the train home. My knee completely gave way underneath me (thankfully I had the handrail to stop a bad fall), and the pain at the outside of my knee was unbelievable. I stopped a second. Holding the handrail I took another step – pain again. I hopped on the good leg down the rest of the stairs, and most of the way home.
What is Iliotibial Band Syndrome ?
The iliotibial band runs along the lateral or outside aspect of the thigh, from the pelvis to the tibia, crossing both the hip and knee joints.
Iliotibial band syndrome is an overuse injury caused by inflammation of the band rubbing against the bony protrusion at the bottom of the femur (femoral epicondyle) at the knee as the knee bends and straightens.
The key symptom felt with ITB syndrome is pain on the outside of the knee. Initially light stinging or pinprick-like sensations may be felt (and often ignored). Untreated, this could gradually increase to sharp or burning pain every time the heel strikes. It’s most noticeable when the knee is flexed (bent) to 30 degrees, when walking or climbing up/down stairs.
What causes Iliotibial Band Syndrome ?
The iliotibial band is an important stabilising structure, a thick piece of connective tissue, that runs parallel to the femur from the hip to the knee. It attaches along the gluteus maximus and tensor fasciae latae on the side of the hip and connects on the lateral side of the tibia.
One of its major functions is to stabilise the knee while walking, running, cycling or hiking. However, if other muscles aren’t functioning properly – specifically those that stabillise the pelvis – gait may change, and the impact then felt through the iliotibial band.
Over pronation or poor foot biomechanics increases the risk of iliotibial band syndrome. As the foot rolls in, the lower leg rotates, and so does the knee – increasing the chance of friction between the knee and the ITB. For some, this may be felt as walking or running begins. For others, it happens as the muscles fatigue during extended walks or runs.
Gluteus maximus and medius control the position of the pelvis and overall stability of the leg during stride. If these are weak, the pelvis may drop to the side when walking, putting strain on the knee.
Other muscle imbalances may also contribute to overall lack of pelvic stability. Quadriceps stronger than hamstrings, weak hip rotators, weak vastus lateralis, or muscles controlling foot arch are some.
For a few people, a naturally tight or wide IT band, leg length differences, or running on cambered roads may make some more susceptible to this injury.
Factors that increase your risk of iliotibial band syndrome include sports with repetitive motions, such as running, walking and cycling. Overtraining, increasing mileage too quickly and/or running up and down hills increase the risk. Damaged or worn out footwear, improper shoes without enough support may also result in over-pronation, causing knee pain.
Traditional treatments include rest, ice, orthotics, anti-inflammatories and physical therapy. These can work for many people, with my learning that the physical therapy chosen needs to not only address the ITB but the cause of the muscle imbalance. The muscles above and below the knee need to be addressed. The pelvis and gait need to be worked on.
It took me a long time to recover from my iliotibial band syndrome. I was up to my third therapist at the clinic, the first two having moved on to different clinics before my knee could cope with longer walks. The orthotics from my second podiatrist seemed to work better than the first. Comments were made about my gait, but how the stretches fit with changing that was unclear. Progress was slow.
For me, there were two changes that helped improvements come fast. The first was finding a local Bowen Therapist. The work helped to balance my hips, helped tight muscles let go, and trigger those non-firing ones to start to work. I remember one evening – my glutes felt completely different after the session and everything really started to change. (It was also the evening that I told myself that I had to learn Bowen Therapy !)
The second change was working with my personal trainer to introduce strength work to help recovery. I was sick of the cycle of rest, then pain, and rest again. He introduced specific exercises to help build weak muscles, help my knee track over my toes (not inward !), work specifically on stabilising my hips, and improving my gait. It was hard work, and I swore at him a lot, but it worked.
A good range of strength exercises to start to help can be found here. Many are the same as the ones I used.
We delayed Kilimanjaro by a full year, but we did make it !
I’d like to say that it was an easy walk. It wasn’t. It was thanks to my determined guide that I made it the whole way, being dragged along up the last section feeling nauseous from the altitude… I felt exhausted, but my knee felt great !