Definition
The iliotibial band (IT band) is a thick band of fibers that begins at the iliac crest (the border of the most prominent bone of the pelvis) in the pelvis and runs on the lateral or outside part of the thigh until it attaches into the tibia (shinbone). The gluteal or buttock muscle fibers and the tensor fascia latae (muscles of the hip joint) attach to it, and the band acts to coordinate muscle function and stabilize the knee during running.
Causes
Inflammation of the iliotibial band occurs because of overuse and is most often seen in marathon or other long-distance runners. Commonly, mechanical issues with poor flexibility and decreased strength in the quadriceps muscles of the thigh lead to the inflammation.
Factors such as leg length discrepancy, an abnormal pelvic tilt, and “bowlegs” (genu varum: genu=knee + varum=angles in) may cause iliotibial band syndrome because of excess stretching of the IT band across the femoral condyle.
Training errors in long-distance runners (for example, running on one side of the road only) may also cause symptoms. Since most roads are higher in the center and slope toward the edge, running on only one side will cause one leg to always be downhill from the other. Runners who fail to recognize this issue are at risk to develop inflammation of the iliotibial band.
Because of the mechanics of running, in contrast to long-distance runners, sprinters tend not to develop this syndrome, but tennis players and bicyclists may.
Treatment and Prevention
Initial treatment for most overuse injuries remains the same: rest, ice, elevation and antiinflammatory medications. Most often, the symptoms occur with an aggressive activity like running; cross-training alternatives like bicycling or swimming may be attempted while the iliotibial band inflammation resolves.
Aside from pain control with antiinflammatory medications, treatment alternatives tend to be recommended in a stepwise approach.
Physical therapy may be a viable treatment option for many patients with iliotibial band syndrome. The therapist may wish to assess running technique and style to look for an underlying biomechanical cause of iliotibial band inflammation. This may include gait analysis as well as flexibility and muscle strength assessment.
The therapist may be able to recommend proper shoes or an orthotic shoe insert to help correct any imbalances or abnormalities.
The therapist may teach specific stretches to loosen tight structures.
In treating the acute injury, phonopheresis (a technique in which ultrasound is used to propel antiinflammatory or corticosteroid medications through the skin into the inflamed tissue) or iontopheresis (an electric charge is used instead of ultrasound to deliver the medications through the skin) may be considered.
If rest, ice, and physical therapy fail to resolve the inflammation, the health-care provider may consider a corticosteroid injection into the inflamed area.
Finally, if all else fails, surgical options do exist. An orthopedic surgeon, using an arthroscope, may be able to break down the scarring surrounding the iliotibial band. If needed, the band can also be lengthened to decrease the stretch and subsequent potential for irritation and inflammation as it crosses the femoral condyle.
If the problem persists, consult your foot doctor.