By Tegan Johnson, D.P.T., C.C.I.
Iliotibial Band (ITB) Syndrome is a common cause of lateral knee pain often found in runners. When faced with knee pain, runners worry about injuries to their ligaments or joint that may affect their ability to run long term. They often discount the possibility that pain can also be caused by connective tissues. The iliotibial band is one of largest connective tissues in the body. Anatomically it is thought to have origins on the ilium, sacrum, gluteus maximus, and the tensor fascia latae (TFL muscle) and insertions in the patella, tibial condyles, and head of the fibula. A team of Professors from Drexel University’s Running Performance and Research Center challenged this current concept at the 2016 Combined Sections Meeting.
Most dissection techniques used to explore the anatomy of the lower extremity cut the iliotibial band and resected it with the skin to study the underlying muscles. Given the high incidence of ITB syndrome, researches at Drexel decided to take a more careful look at the structure and function of the ITB. With more thorough dissection of the ITB it was found that the band actually originates as previously thought along the ilium, sacrum, and surrounding muscles, but also the entire length femur. Given this extended attachment, anatomist were able to demonstrate the true strength of the attachment ITB facia with its ability lift the entire weight of the lower extremity in a cadaver. (David Ebaugh, PT, PhD, Kevin Gard, PT, DPT, OCS, Robert Maschi, PT, DPT, OCS, CSCS, & Clare Milner PhD, FACSM, personal communication, February 20, 2016).
So what does this mean for runners? If the attachment of the ITB is actually along the entire length of the femur, then friction of the ITB on the femur is NOT a likely cause of knee pain. The new thought is that the signature lateral knee pain diagnosed as ITB syndrome is caused by compression of the sensitive nerves and fat pad under the ITB along the lateral knee secondary to poor mechanics. One likely cause is an imbalance between the gluteal and the TFL muscles. These imbalances can cause stress and pain in joints adjacent, above, or below the ITB.
Current treatments for ITB include manual therapy techniques, foam rolling and stretching of the ITB, strengthening of the gluteal muscles, taping techniques, ice, and gait training. We may see slight variations of these traditional treatments as physical therapists assimilate this new knowledge of anatomy into their practice. If lateral knee pain is slowing you down this spring, you may want to consult with a physical therapist for a thorough assessment of your body mechanics and check for muscle imbalances that may be contributing to your pain.
Reference: Ebaugh, D. PT, PhD, Gard, K. PT, DPT, OCS, Maschi, R. PT, DPT, OCS, CSCS, & Milner, C. PhD, FACSM. (2016, February). Anatomy and Biomechanics of Running Injury: From Cadaver Dissection to Practical Interventions. Paper presented at the Combined Sections Meeting of the American Physical Therapy Association, Anaheim, CA.
About the Author:
Tegan encourages her patients to incorporate their rehabilitation and fitness goals into their daily activities. Tegan uses a multitude of treatment techniques including but not limited to manual therapy, Pilates-based exercise, therapeutic exercise, manual lymphatic drainage, multi-layered bandaging, taping techniques, custom orthotic evaluation, habituation exercises, gait training, sports specific injury prevention, and postural education. At home, Tegan is a wife and mother of three very active and healthy children.