ITB Friction Syndrome

Iliotibial band (ITB) friction syndrome is a widespread overuse damage that typically results in a burning discomfort on the outer side of the knee. ITB is a dense band of connective tissue that extends from the hip to the outer shinbone, and plays a key role in stabilising and supporting the knee joint. When the ITB repeatedly rubs against the external part of the thigh bone, it can become irritated and lead to discomfort in the end.

Symptoms of ITB Friction Syndrome

The primary symptom of ITB friction syndrome is pain on the outer side of the knee. This normally occurs during physical activity and improves with rest.

Repetitive knee movements, like cycling, running, or climbing stairs, often trigger the pain. It may also intensify as the activity continues. Runners, in particular, may experience a gradually increasing burning sensation that eventually forces them to stop. However, the discomfort usually subsides quickly after resting.

Other common symptoms are:

Localised swelling or puffiness on the outer knee
Tenderness when the affected area is touched
A popping or clicking noise in the knee

Risk Factors

ITB friction syndrome mostly occurs in cyclists, runners, and other athletes who engage in activities involving repeated bending and straightening of the knee. Moreover, it is frequently seen in individuals with tightened hamstrings or weakened quadriceps muscles.

Diagnosis

Healthcare providers normally diagnose iliotibial band friction syndrome through a medical history review and physical examination. During the evaluation, the doctor will:

Ask about your symptoms, physical activities and any factors that may have contributed to knee pain
Examine the knee for swelling, tenderness, and range of motion
Assess for pain along the outer knee, especially over the lateral femoral condyle (LFC), where the ITB rubs against the bone

Imaging tests like ultrasound or MRI may be recommended to confirm the diagnosis and rule out possible causes of knee pain. An ultrasound may reveal fluid build-up and swelling in the affected area. Also, applying pressure with the ultrasound probe over the LFC may replicate discomfort, further supporting the diagnosis.

Treatment

The majority of ITB friction syndrome cases can be managed with conservative treatments, including:

Rest: Avoid activities that worsen the pain, like running or cycling.
Ice therapy: Apply ice or cold packs to the affected region for about 10-15 minutes several times a day to reduce inflammation.
Painkillers: Over-the-counter medications like paracetamol, ibuprofen, or naproxen can help alleviate mild to moderate discomfort and inflammation.
Physiotherapy & strengthening movements: Strengthening the hamstrings, quadriceps, and calf muscles can improve knee stability and reduce strain on the IT band. Addressing biomechanical issues like improper running form or abnormal foot mechanics is essential in preventing recurrence. Sometimes, podiatry assessment may assist in correcting foot imbalances that contribute to knee pain.

Additional treatment options for ITB friction syndrome

In cases when conservative treatments do not give sufficient relief, these additional interventions may be considered:

Corticosteroid injections. These can help reduce inflammation and pain in the affected area. A small dosage of corticosteroid and local anaesthetic is injected deep into the ITB, over the LFC.
Surgery. This is usually the last resort and is recommended if conservative methods and steroid injections are ineffective. It aims to release the ITB and relieve pain.

Conclusion

Iliotibial band friction syndrome is a frustrating and painful condition. It can, however, be effectively managed with the right treatment and preventative measures. Generally, addressing this disorder early can help prevent more complications and get you back to your activities pain-free.