Iliotibial Band Syndrome (ITBS)
The iliotibial band (IT band) is a band of fibrous tissue (fascia latae) that runs down the outside of your thigh from your hip and all the way down to your knee. It provides stability to the hip and knee and its job is to prevent the dislocation of both knee and hip joints.
When the band becomes tight it compresses the tissue around the hip bone or the outside of the knee joint. This compression of the tissue affects the hip, leg muscles and the knee (reference: 1).
Iliotibial band syndrome (ITBS) is a common condition in athletes, especially runners and cyclists, and occurs when the IT band becomes irritated, inflamed and tight. The IT band (also called the iliotibial band or iliotibial tract) is a thick, fibrous tendon that runs along the outside of each leg. These bands run from the iliac (crest of the pelvis), over the greater trochanter at the side of the hip, down the leg, and inserts on the outside of the knee at the top of the tibia (tibial tubercle). Each IT band works with the thigh muscles during flexion and extension of the knee to slow you down when running and helps provide stability to the knee joints.
Excessive rubbing of the IT band over the tibial tubercle (bony prominence at the outside of the knee) is a common cause of the irritation that leads to inflammation, tightness and pain. Although the pain from ITBS usually occurs at the outside of the knee, soreness in the hip may also occur. Pain in the hip is usually caused by the IT band tightening and rubbing over the greater trochanter, the outer hip bone.
The initial pain of ITBS is caused by the tightening, irritation, and inflammation in the IT band. As the IT band starts to heal, scar tissue begins to develop on the iliotibial tract. This scar tissue is tough and inflexible and it stops the muscles attached to the IT band from moving smoothly. This causes further pain at the knee and tightness is usually felt in the hip and down the leg to the knee.
Symptoms of Iliotibial Band Syndrome
Symptoms of ITBS in runners usually begin with pain developing during a run which subsides shortly after the run finishes. Pain continues to appear with every run eventually progressing to more constant pain while walking or going up or down stairs. Typical symptoms experienced are:
- Pain at the lateral (outside) knee and hip
- Swelling over the hip (greater trochanter) and outer knee
- Knee Pain, possibly accompanied by Hip Pain
- Stiffness running down the side of the thigh
Causes of Iliotibial Band Syndrome
Iliotibial band (ITB) syndrome (ITBS) is common for people who participate in sports that require running or repetitive hip and knee movements (flexing and extending the hip/knee/leg). Sports such as long-distance running, cycling, tennis, soccer, skiing, weight lifting and aerobics can lead to IT band issues. Iliotibial Band tendonitis is also often referred to as an overuse injury.
If you look at the bottom of your shoes you'll soon notice the uneven or excessive wear in certain spots. These wear patterns on the soles of your shoes show how your foot is striking the ground (your gait). If you are noticing excessive wearing of your shoes in certain places your gait (the way you walk) may be off. Wear patterns also may show if your foot is rolling inward or outward (pronation or supination). Your hip alignment or leg-length may also tighten your Iliotibial Band.
Everything is connected in our bodies - the way you walk including the placement of your foot may depend on whether you have knee and/or hip issues and other injuries. Improper gait can cause IT band issues and an improper gait can happen due to a large number of factors including short leg syndrome (SLS), back problems, hip problems, knee and ankle problems and even improper footwear. If you are suffering from IT band pain you're probably also suffering from another injury in your hip, knee and/or foot or from a natural issue with your gait (flat-feet, fallen arches, over-pronation or short-leg syndrome).
Risks of Contracting Iliotibial Band Syndrome
The risk of a person contracting iliotibial band syndrome can increase with any condition or activity that may cause excessive rubbing of the IT band, such as:
- Increasing training distance or intensity to quickly
- Performing squats while lifting weights
- Poor form when biking (i.e. incorrect cleat position, saddle height or positioning from bars)
- Improper shoe fit when running
- Running on a slanted surface or downhill
- Muscle imbalances (i.e. weak hip abductor, quads more developed than hamstrings)
- Poor foot structure (flat feet, pronation), an awkward gait (i.e. bow-legged, knock knees), or abnormal leg lengths
- Playing court sports with frequent stopping movements (i.e. tennis, handball)
Tests for Iliotibial Band Syndrome
(IT Band Diagnosis)
The best way to diagnose this condition is with a quick visit to the your doctor or physical therapist for a physical examination of your hip, leg and knee. Your Doctor might have you perform a Noble Compression Test (a flexibility test) where they see how flexible your IT Band and hip flexors are. During this test your doctor or physical therapist will have you lay on your back and perform a few movements of your leg and hip to discover if there is inflammation in either area.
Your doctor will do a physical examination which may include range of motion tests. He or she may arrange x-rays and/or an MRI. An x-ray will rule out calcification or bone spurs in the area. An MRI can identify the inflammation or damaged IT band. It can also determine if there is any other damage in the soft tissue neighbouring the iliotibial tract.
Treating IT Band Syndrome (ITBS)
Initial treatment of iliotibial band syndrome should focus on resting your leg and reducing the inflammation to help relieve pain. Do not train through the pain. It may be necessary to stop training for a week or two.
Treating your iliotibial tract with cold compression and Circulation Boost will reduce the pain and inflammation so you can get back to training sooner. However, once the pain is gone it does not mean you are healed. Absence of pain generally means the swelling and inflammation is gone, but it takes quite a while for the underlying injury to heal. This is why you get flare ups after you start getting active again (once the pain is gone) - you are still injured and must heal the injury completely!
Use a Cold Compress or Ice Pack For Relief From Pain & Swelling
When your IT band becomes inflamed and sore during a run, doctors recommend immediate treatment with cold therapy. Cold therapy is the safe and natural way to control pain and swelling while minimizing tissue damage. Frequent, cold treatments within the first 72 hours of the iliotibial tendon becoming inflamed is an effective way to relieve pain and swelling while limiting the amount of damage done to your tissue. In addition, cold therapy can reduce, or even eliminate, the need for NSAIDs (non-steroidal anti-inflammatory drugs) that can be harmful to your body.
Cold works by interrupting and slowing nerve and tissue function in the injured area and reducing swelling that can block blood vessels. This is important because once blood vessels are blocked or damaged, they can no longer carry oxygen and nutrients to your iliotibial tract and tissues begin to break-down. Without cold therapy, cellular break-down and tissue damage continues because the cells do not get the oxygen they need to survive.
T•Shellz Wrap® Circulation Boost
When you stop moving your hip because it hurts the amount of blood that flows naturally to your acetabular joint is reduced, limiting your body's natural ability to heal itself. This why massage, PT and stretches are all considered important in rehab - they are all designed to (1) induce more blood flow to the injury area so you can heal faster, and (2) keep your soft tissue (muscles,ligaments,tendons) stretched and flexible to help prevent atrophy.
Even though the concept is simple, improving blood flow to injured tissues can be difficult. Traditional methods require your muscles and tendons to move to promote blood flow (exercise), but that same motion that promotes blood flow can at times lead to making your pain and condition worse.
Heat energy generated by the T•Shellz Wraps® operate by increasing blood flow in our injured soft tissue. This means ligaments, muscles, and tendons. The objective of the T•Shellz Wrap® is to relax blood vessels - these vessels then gently expand, allowing for more nutrient rich blood flow along with extra oxygen to reach the damaged tissues. Plus, the enhanced blood flow helps in flushing waste and fluid build-up from the injury site - further enhancing the ability of the body to heal.
Once the inflammation in your IT band has been reduced with cold therapy it is time to take the next step in your IT band treatment. Use a Back/Hip T•Shellz Wrap® to improve blood flow while simultaneously helping surrounding soft tissue to become elongated and more elastic. T•Shellz Wraps® are basically the perfect tool to use at home to help augment your massage and PT sessions to help keep your blood moving.
Improved blood flow helps reduce the risk of atrophy in muscles. When you stop moving your leg and hip due to pain, your muscles and other tissue can become weaker and dead tissue and toxins in the area can cause further tissue deterioration - this can lead to atrophy in your quadriceps, hamstrings, glutes and many other muscles in the thigh, groin, lower back, knee and hip. The Back/Hip T•Shellz Wrap® is a tool that can be used to treat your entire core area. We have T•Shellz Wraps® for every major joint of the body.
By clearing the area of toxins and increasing the amount of oxygen and nutrients to soft tissue in your hip, the risk of atrophy (muscle weakness and/or deterioration) is greatly reduced. Keeping your hip and leg tissue as healthy as possible throughout the healing process will allow you to improve strength again once your pain has gone and your IT band has healed.
Why Use a Back/Hip T•Shellz Wrap® (Heat) For Your Hip?
HEAT (warmth) is used after you've reduced your swelling / inflammation and the sharp pain is less intense (you have more of a dull / nagging ache and soft tissue tightness in your hip). Warming up tissue in the area is a natural way to encourage healing of muscles, tendons and ligaments. It's the blood in your body that will bring oxygen, nutrients and water (basically energy) to your injured hip to help with healing.
When heat is applied to the hip, veins and blood vessels will start to get bigger (expand) to allow more blood flow through to your damaged or torn soft tissue. This in turn relaxes your hip, making the tissue more flexible and elastic. This is why heat is used on older (chronic) injuries, to loosen tissue and bring in the blood flow needed for soft tissue to repair. Your body will begin to heal itself after it is injured - increasing your blood flow with heat will, in most cases, speed up this natural process - often surprisingly well.
Doctors usually call this process 'Vasodilation'.
Heat can Make Inflammation, Swelling and Newer Injuries Worse - How?
When we injure ourselves, we start healing right away. The body will naturally raise the temperature at the site of the injury resulting in the inflammatory response (redness, heat sensation, inflammation and swelling). This 'fake fever' leaks blood flow to the area to cool it down and start the healing process.
Adding 'heat' to your hip when it's already inflamed and tender may make your body think there's a new threat to your tissue and increase the pain in order to get you to stop. For some people applying heat on inflamed / swollen tissue will cause the injury to swell-up even more (as much as 3 times larger than normal). You'll feel even more pain as the pressure builds in your hip.
Heat is NOT a good treatment method for inflamed soft tissue, new injuries (within the first 24 to 72 hours), right after surgery or right after a re-injury (over-use and/or sharp, throbbing pain). In these cases, heat should be applied later on in the healing cycle. In the meantime, use a Cold Compress or Ice Pack to decrease any inflammation induced pain.
The primary intent of a heat based application is to increase blood flow circulation and, as such, stimulate the body's own natural recovery process for older (chronic) or recent (acute) injuries, long-term post surgery recovery and more recently - for some regenerative therapies performed by doctors and pts. Warmer temperatures should be used approximately 3 to 5 days after you first have the injury or even later if the swelling has not reduced significantly. Heat should not be started for a least 2 weeks after surgery because inflammation levels will be very high as the healing process starts over again. Any use of heat should also be combined with gradual movement to stretch out your hip and increase range of motion.
If you have a chronic hip injury that keeps getting re-injured you should use heat before activity to loosen up your tissue (making it more flexible). When used at this time the warm temperatures naturally extend the elasticity (elastic-nature) of the joint, making it more movable / pliable for activity.
Sometimes we feel pain while doing a certain activity - should you still use heat? Using heat in the morning before you start your day or before activity can help to boost the healing process and reduce your risk of re-injury. Too much heat (especially when you suffer a set-back with swelling / inflammation) can make your inflammation worse. Cold treatments with a Cold Compress or Ice Pack should be used part-way through your day when you suffer from on-going pain and inflammation as a natural pain-reliever.
Keep using a T•Shellz Wrap® before activity and when you notice any stiffness in your hip to 'warm up' your muscles, tendons & ligaments - this will help them stretch further during activity and help reduce risk of further tearing.
Using heat is a good long-term plan because it can be used on a preventive basis to relax constricted soft tissue. Heat will increase the volume of blood circulation, which in turn, brings all the components your body needs to heal more efficiently - oxygen, nutrients, anti-bodies and energy.
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How to Use Consistent Deep Hip Stretching for Improved Hip Flexibility & Health
For many people, the treatment doesn't just end with Heat and/or Cold applications. Stretching is plays an important part in hip soft tissue recovery - and it's the final step needed when healing your injury with conservative treatment methods.
You would be surprised by how many people there are that don't understand the importance of stretching a deep tissue hip injury. Before returning to full activity after a hip injury, physical therapists prescribe gentle stretching of the affected area... This is because stretching an important part in recovery from any soft tissue injury. Consistent stretching is one of few solutions available to break up scar tissue that forms on your hip as it heals.
Stretching your hip is even more powerful
when combined with:
- A Back/Hip T•Shellz Wrap to increase elasticity of tissue and stimulate blood flow in the injured hip before stretching.
- A Cold Compress or Ice Pack to reduce pain and inflammation in the affected tissue after stretching.
Anti-Inflammatory Medications for IT Band
NSAIDs, non-steroidal anti-inflammatory drugs, can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The T•Shellz Wrap®, when used in conjunction with NSAIDs can greatly improve the effect of the medication; this can not only help you heal quickly but also reduce the amount of NSAIDs that you ultimately may require.
PT is a beneficial way to restore atrophied muscles and improve strength and mobility when suffering through a long term debilitating hip injury. The type of PT and the duration will be dependent on the tissue damage and your symptoms. When you are treating or recovering from IT Band syndrome, it is important to ensure you do not perform any exercises that will further irritate the condition.
Once your pain starts to diminish, a physiotherapist will set up an individualized strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return
to performing your normal routines.
Individuals will often lift weights on their own, to try and build up their strength. However, in doing so, they can do more damage to their joint. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is appropriate and effective. For best, long term results use T•Shellz Wraps® at home, in conjunction with PT and an exercise program.
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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!