Blog post produced and written by Clinic Manager and Sports Injury Specialist Jason Dodd.
ITB syndrome can often be termed ‘runners knee’ and has a high prevalence amongst endurance athletes (cycling, running, etc….). The symptoms are often described as a pain on the lateral part of the leg/knee which comes on after a set duration of activity and then continues to get worse.
In the past this has always been attributed to a ‘friction’ like movement of the ITB over the lateral (outside) bone of the femur which over time causes an irritation and then pain. It makes perfect sense in a logical way. The band rubs continuously over a raised head and eventually inflammation occurs. Well, evidence and research are now showing this may not be true.
Whilst I know this may be controversial to say this and probably goes against everything you have ever heard, and probably doesn’t even make logical sense that it can be debated but let me try and explain the research before you dismiss my statement 😊!
ITB pain – it cannot be friction
First, the anatomy of the ITB is not that of a singular band type muscle/fibre that many imagine it to be. Instead, it is a bundle of fibres with wide and dispersed attachment areas along the thigh bone and into the kneecap region. It has also been proven that the ‘motion’ occurring at the ITB insertion at the knee is in fact very limited, and doesn’t move much at all, therefore going somewhere to disproving the ‘friction back and forth’ theory once believed.
Next is the role of inflammation and how it effects the bursa in that area. Many studies have now shown that in fact it is not the bursa that is aggravated at all in this condition but instead they have identified the presence of a fat pad in the region. Our understanding of fat pads is that they are highly innervated so this would go someway to explaining the high levels of pain felt in the knee area when it becomes irritated. It has also been found now that the cells released during the inflammation of a fat pad can have a direct impact on tendinopathies and given the close relationship the ITB has to tendon properties it is no surprise that it can affect it in a very negative way.
Finally, the ITB can sometimes be referred to as ‘tight’ and can lead to us trying to stretch it and lengthen it through foam rolling and other methods. This ‘tightness’ would help support the theory of ‘rolling over’ the outside part of the knee but studies have shown that to lengthen the ITB you would need a force of over 900kg to gain just a 1cm increase. So, if we know that the ITB cannot be lengthened then why do people get better?
What is it then?
Well, emerging evidence now suggests the pain we have in our ITB is created from the ‘strain rate’ that the ITB must absorb when working. This accumulative load creates pain in a similar way to how knee pain comes about in those with PFP.
Why does this all matter though? That’s a very good question! The main reason for feeling the need to explain this is due to something known as kinesphobia. Kinesphobia is the fear of movement or of performing certain tasks. If we believe that something is caused by ‘friction’ then we will forever think that if we get pain, then we should never do that again as it is always going to create ‘friction’. BUT if we know that the pain we are experiencing is due to an overload of the tissue structure and it is reacting in a similar way to a tendon (as explained above) then the athlete/patient can rehab the problem effectively without the long term fear of it occurring again ‘regardless of what they do’. This for me is why it is important to know 😊!
If you are suffering from ITB pain and want to get it seen to or to gain a second opinion, then contact us now at Bodylogics and we will get you booked in to see one of our expert clinicians who can help you out with your pain and get you back to where you should be.
