IT Band Issues in Triathletes

The Iliotibial Band also know as the iliotibial tract or IT Band is a fibrous reinforcement or a strip of connective tissue that connect three muscles ( the tensor fasciae latae, the gluteus maximus, and the gluteus medius muscle) to the lateral thigh and leg providing stability to the knee and hip and preventing griperthe dislocation of those joints. It functions to extend and as an abductor, a medial rotator and as a flexor of the thigh. It also plays a role in helping the tensor fasciae latae and gluteus maximus support the extension of the knee while standing or doing other activities. The Iliotibial Band (ITB) Syndrome is a condition that results due to friction of the tract across the tissues on the lateral side of the thigh.

Causes of Iliotibial Band Syndrome

The movement of ITB is posterior over the lateral condyle of the femur and anterior when the knee is extended. Frequent repetitive movement particularly due to overuse such as cycling, hiking, etc., can result in the inflammation of ITB. Some other causes of Iliotibial Band Syndrome (ITBS) include:

  • Muscle imbalances – Mechanical imbalances in the body that results in the poor flexibility of the muscles particularly the pelvis, the knees, the hips and the low back.  In many cases, weak quadriceps or hamstrings can be linked to many other leg joint issues.
  • Poor training habits – inadequate warm up and cool down, hiking long distances, consistently running on horizontally banked surface. Etc.
  • Anatomical abnormalities – Anatomy issues such as a difference in the length of the legs, the abnormal tilt of the pelvis causing the ITB to become tight and leading to friction, high or low arches, bowlegs, excessive foot strike force.
  • Various sports that places stress on the iliotibial band

Symptoms of Iliotibial Band Syndrome

A variety of symptoms could result due to ITBS: Pain on the outer part of the knee, swelling and thickening of the tissue in the location, stinging sensation above the knee joint or when the foot strikes the ground. The pain may also persist after certain activities.

To diagnose that a patient is suffering from ITBS often involves the patient describing the kind of pain being felt during certain movement, swelling can also be seen and felt near the femoral epicondyle.

  • MRI scan – helps locate inflammation and exclude other causes of outer knee pain
  • Physical examination – the physical examination of the knees and ankles for potential cause of the pain
  • Discrepancies – the doctor could search for leg-length discrepancies, muscle imbalances, tightness in the leg and back, pelvic tilt.

Treatment of Iliotibial Band Syndrome (ITBS)

In general, the treatment for ITBS start with the RICE (rest, ice, compression and elevation) method. The syndrome is mainly due to overuse resulting in inflammation.  Ice should be applied several times a day in whatever way provides deep cold penetration but is still comfortable.  Compression can be done manually or by using compression gear such as shorts or socks.  For cyclists, you may find that using the best cycling shorts rather than off-brand or cheaper shorts offers better compression and alignment.  ITBS is just such a delicate injury that any adjustment might help.  At occasions anti-inflammatory medication may be prescribed. When no result in obtained from RICE or medication, physical therapy is necessary. Two main types of treatment non-surgical and surgical can be administered depending on the severity.

  • Non-surgical treatment – ultrasound may be used to propel anti-inflammatory medication in the affected location . When the problem is the result of discrepancies, orthotic shoes can be recommended.  Keeping the inflammation down is critical, whether you decide to use ice, ultrasound, or medication.
  • Surgical treatment – In some cases when non-surgical treatment does not produce any result, orthopedic surgery may become an option. An Arthroscopy is used to locate and cut the inflammation around the iliotibial band or retrieving part of the iliotibial band to allow room for it to move freely across the bone.
  • Physical therapy – In certain circumstances the RICE procedure produces temporary result meaning that once activities have started again, the inflammation may reoccur. Abnormal movement of the pelvis can result in the ITB pulling away from the knee. In such case strengthening the muscles that stabilizes the thigh can help to control excessive movement. Some exercise that strengthens the musculature include: Hip trust, side leg raise exercise, pistol squat, side hip bridge, foam roller IT Band, Hip flexor stretch, outer quadricep tender point exercise.
  • Stretching – It has been found that keeping the entire series of leg muscles loose is critical to preventing the onset of ITBS.  Foam rollers can help in the stretching.

Prevention of Iliotibial Band Syndrome

Preventing ITB injuries involves taking the necessary steps not to overuse or stress the ITB. The most essential method of prevention for athletes is to use the right kind and quality shoes depending on sport. Runners should also try to maintain a constant pace and not force too hard and undertake frequent exercise to strengthen the musculature.


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