iliotibial band syndrome

What is iliotibial band syndrome?

Iliotibial band syndrome is inflammation and pain on the outer side of the knee. The iliotibial band is a layer of connective tissue on the outside of the thigh. It connects a muscle near the outer side of your hip to the outer side of your upper shin bone (tibia) in your lower leg.

What is the cause?

Iliotibial band syndrome happens when the iliotibial band gets irritated from rubbing over the bump of the thigh bone near the knee. This most often happens when you are running.

This problem may happen because you:

  • have a tight iliotibial band
  • have tight muscles in your hip, pelvis, or leg
  • have legs that are not the same length
  • run on sloped surfaces
  • run in shoes with a lot of wear on the outside of the heel

What are the symptoms?

This problem causes pain on the outer side of the knee.

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How is it diagnosed?

Your healthcare provider will ask about your symptoms, review your medical history, and examine your knee.

How is it treated?

To reduce swelling and pain in the first day or two, your provider will probably tell you to:

  • Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth, on the injured area every 3 to 4 hours for up to 20 minutes at a time.
  • You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the painful area for 5 to 10 minutes. Do this several times a day while you have pain.
  • Take an anti-inflammatory medicine, such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.

Your provider may give you an injection of a steroid medicine.

How long it takes you to recover depends on many factors, such as your age, health, and history of previous injuries. A mild injury may get better in a few weeks, but a severe injury may take several months to heal. You need to stop doing the activities that cause pain until the iliotibial band has healed. If you keep doing activities that cause pain, your symptoms will come back and it will take longer to recover.

How can I take care of myself?

  • Follow your treatment plan.
  • Follow your provider’s instructions for doing exercises to help you recover.
  • While your knee heals, you will need to change your sport or activity to activities that don’t make your problem worse. For example, ride a bicycle instead of run.
  • Contact your healthcare provider if you have new or worsening symptoms.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your knee recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely go back to your normal activities when:

  • Your injured knee can be fully straightened and bent without pain.
  • Your knee and leg are again as strong as your uninjured knee and leg.
  • You can walk or jog straight ahead without limping.

How can I help prevent iliotibial band syndrome?

The best way to prevent this problem is to warm up properly and do stretching exercises before sports or other physical activity.

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You can start gently stretching your calf muscle with the towel stretch right away. Make sure you feel only a gentle pull and not a sharp pain in your calf while you are doing the stretch.

Wearing a quarter to half-inch heel lift in each shoe might reduce your pain as you start to recover from your injury. You can purchase heel lifts at most pharmacies. You can stop using the heel lift when you have no pain while walking.

  • Towel stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your leg straight. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times.

After you can do the towel stretch easily, you can start the standing calf stretch.

  • Standing calf stretch: Stand facing a wall with your hands on the wall at about eye level. Keep your injured leg back with your heel on the floor. Keep the other leg forward with the knee bent. Turn your back foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Do this exercise several times each day.

After a couple days of stretching, you can begin strengthening your calf and lower leg muscles using elastic tubing as described in the next exercise.

  • Resisted ankle plantar flexion: Sit with your injured leg stretched out in front of you. Loop the tubing around the ball of your foot. Hold the ends of the tubing with both hands. Gently press the ball of your foot down and point your toes, stretching the tubing. Return to the starting position. Do 2 sets of 15.

You may do the last 4 exercises when you can stand on your toes without pain.

  • Heel raise: Balance yourself while standing behind a chair or counter. Using the chair or counter as a support to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It’s OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try lowering yourself down on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.

You can challenge yourself by standing on just your injured leg as you do this exercise.

  • Single leg balance: Stand without any support and try to balance on your injured leg. Keep standing on the one leg for 30 seconds. Repeat 3 times. Begin with your eyes open and then try to do the exercise with your eyes closed. When you have mastered this, try doing the exercise standing on a pillow.
  • Nose touch: Stand on one leg facing a wall. Stand 4 inches from the wall. Keep your body and leg straight. Slowly lean forward, trying to touch your nose to the wall and then return to the starting position. Make sure you do not bend forward at your waist. Do 2 sets of 15.
  • Wall jump: Face a wall and place a piece of masking tape about 2 feet above your head. Jump up with your arms above your head and try to touch the piece of tape. Make sure you do a “spring” type of motion and try to land softly on your feet. As the exercise gets easier, jump on just your injured leg. Do 2 sets of 15.

Another good exercise is hopping. You can start at one end of the room and try to hop as high as you can across the room on one foot. Jumping rope is also a good exercise.