What a Pain in the Knee! IT Band Syndrome

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Sometimes, in our quest to stay healthy through exercise or to excel at a sport, we can push ourselves too far, and injury or chronic pain can result. 

IT band syndrome — pain on the outside of the knee — is an example of just such a problem. People who suffer from IT band syndrome are often involved in long-distance running. But it can also strike those who engage in other athletic activities, such as skiing and cycling, or simply exercising.

The IT (iliotibial) band is a thick cord of fascia, similar to a tendon, that runs along the outer thigh from your ilium (hip bone) to the top of your tibia (one of the two major bones in your lower leg). It's an elastic tissue that acts something like a spring and may serve to help make running more energy efficient. 

Many patients respond well to these treatments and can eventually get back to the activities they enjoy.

The Symptoms of IT Band Syndrome

Each time you bend and straighten your leg, the IT band rubs across the bone on the outside of your knee. Over time, that rubbing can lead to irritation of the band and other tissues in the area (nearby bones, tendons, and small fluid-filled sacs called bursa) resulting in the pain that's familiar to sufferers of IT band syndrome. 

That pain has been described as a burning, aching sensation that can spread from the knee all the way up into the hip. Sometimes it's noticeable only when you're exercising, but as the condition gets worse, the pain can continue well after the exercise has stopped. It can also be made worse by running downhill or by walking up and down stairs. Even sitting with your knees bent for long periods of time can bring on the pain.

How IT Band Syndrome Is Diagnosed

A doctor will diagnose IT band syndrome based on a physical examination and your answers to questions about your symptoms and physical activities. During the physical exam, the doctor will see how strong your knee is and how well it's able to move through its typical range of motion. Since the symptoms of IT band syndrome can be similar to those of other conditions (including arthritis), it may be necessary for your doctor to request further diagnostic tests, including an X-ray or MRI scan.

Treating IT Band Syndrome

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There are two main goals in the treatment of IT band syndrome:

  • Reducing the pain and inflammation: This is often managed with the use of ice packs, anti-inflammatory and pain-management medications, massage and rest. In some cases, doctors will give a cortisone shot to help reduce the pain and swelling.
  • Using rehabilitation techniques to help keep the problem from coming back: These can include stretching and strengthening exercises to help the IT band and nearby muscles remain limber and to increase the strength of muscles in the hip that can help keep the IT band from rubbing so aggressively against the bone at the knee. Your doctor may recommend that you see a physical therapist to help you learn the proper exercise routines so that you can heal as quickly as possible. 

Many patients respond well to these treatments and can eventually get back to the activities they enjoy. If medicine and therapy don’t work, doctors might recommend surgery to alter or remove part of the IT band or nearby tissues.

What Can You Do?

Since IT band syndrome can arise due to habits that you develop over time, you may be able to help your knee (or prevent potential future IT band problems) by changing those habits. You may benefit from consulting with a qualified trainer or sports medicine specialist who can help identify and correct any errors or potential trouble spots in your training regimen. Some common advice includes:

  • Don't overtrain. Stick to reasonable distances, and don't increase your mileage too quickly. The general rule of thumb is to increase by 10 percent of your total miles per week.
  • Avoid running across sloped surfaces or downhill for long periods.
  • Don't run on worn-out shoes. Replace them every 300 to 500 miles. Pay special attention to the midsole, the part of the shoe that sits between the upper and the outsole and provides protection from impact forces. It’s the section most likely to break down and lead to injury. 
  • Take a day or two per week to cross-train with cycling, swimming or the elliptical trainer to help prevent injury.
  • Warm your knee before running by doing both dynamic and static stretches and rolling the IT band. If you’re in pain afterwards, apply ice to the knee.
  • Some people with symptoms benefit from the use of kinesiology tape, available widely.

If your running or exercise routine continues to cause pain, you may need to consider shortening your distances or even switching to a different form of exercise.