Jan 2017 14

ITB Syndrome

By: Dave Wheeler

Many of my clients will know that I have a thing about the ITB (the Iliotibial Band). In my experience in the treatment room too many people muck about with their ITB because other people do without ever needing to.

Horror stories of problems with the ITB abound in running clubs and on forums on the web, so better safe than sorry, right?

One of the problems with Dr Google is that it can be easy to mis-diagnose yourself.


How common is ITB syndrome?

For runners and cyclist, particularly, nowhere is this more true than of Iliotibial Band (ITB) Syndrome.

If you do a quick web search for "knee pain" most of the results will tell you that you have ITB syndrome.

Now ITB syndrome is a really painful condition that can put an end to your running. (Actually it's not limited to runners, one client in his early 30's walks half an hour to work and back each day and he developed ITB syndrome).

The problem is the misinterpretation that's  around on the web. One of  the most popular running magazines, Runners' World says, "Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners." Which of itself is true if you read the words literally. Not the most common; not even 1 of the most common, but 1 of the most common overuse injuries. It's somewhere up there in a common group of a certain type of injury called overuse injuries.

(By the way, there's a great article in the blog here on overuse.)

So we've established that ITB syndrome is  one of the most common type of a certain type of injury  amongst runners (and cyclists,  by they way). But what does this actually mean? What's the science? How many people actually get a problem with their ITB?

Here we can get a bit more precise. Studies have shown that ITB Syndrome accounts for somewhere between 1.6% and 52%, which is a pretty wide range!

So we need to understand what the stats are actually measuring (and who they're measuring).

If a study shows that 22% of lower limb injuries in a female college basketball team were due to ITB  syndrome, the question to ask is, who cares? I don't mean to be more grumpy than normal, but really, who cares? What possible use could that fact have on your cycling or running?

For normal people who exercise around the rest of their life, 4 different studies over more than a decade put the incidence  of ITB Syndrome at 12% of all overuse injuries. So of runners and cyclists who get an overuse injury, 1 in 8 of those overuse injuries will be to do with the ITB. (Barber & Sucker, 1992; Clement et al, 1981; Noble, 1980; Evans, 1979).

People who run aggressively downhill a couple of times a week or more, who cycle for hour a day or more, or who run one way round a track all the time are those where the incidence of  ITB syndrome is higher (fairly obviously,  because they're  overusing in a particular way). For mere mortals who's training is a bit  more balanced (even haphazard) the incidence is closer  to 1.6%.


Diagnosing Iliotibial Band Syndrome

The 1st, and most important, thing to think about is location. ITB syndrome affects the side of the knee. With  your leg straight or nearly straight,  reach down the side of you leg to the outside of your knee. You should feel a knobbly lump. This is where the ITB joins the bone and is where ITB syndrome will have affected you if you've had it. 

If you've got pain at that knobbly bit when you run or cycle, then the most likely cause is ITB syndrome. If the pain isn't there then it most definitely isn't ITB Syndrome.

The 2nd thing is to differentiate between pain and ache. ITB  syndrome is characterised by pain. So if you get an ache the next day after running toward the side of your leg down toward the knee, that's DOMS associated with hard exercise. Again, it's not ITB Syndrome.

The final thing to help diagnose ITB syndrome,  assuming you've got the location and pain right, is that it'll almost certainly be painful at that knobbly bit at the side of the knee when you walk downstairs.


What next?

So we've  seen how common ITB syndrome is (and  isn't) and how  to diagnose it.  But there are still more obvious questions - what can you do about it  if you have it,  and just what is the ITB anyway?

That's too much for one blog, so more next week.

Stay tuned. (And in this weather,  stay warm)