ITB syndrome is a frequently written about overuse injury that causes knee pain. Characterized by pain on the outside of the knee joint (lateral knee pain), ITB syndrome can bring runners to their knees, literally! But with the reported incidence of ITB syndrome, ranging from 1.6 percent to 52 percent, does everyone experiencing lateral knee pain suffer from ITB syndrome?

The ITB is vitally important. It is a thickened band of connective tissue or fascia with attachments to the quadriceps, hamstrings, and glutei. Originating in the hip at a small sausage-shaped muscle known as the tensor fascia lata (TFL), its role is to transfer load between the glutei, quadriceps, and hamstrings, improving the stability and force generation of the lower limb. Despite the preoccupation with "stretching" the ITB to prevent ITB syndrome, it is inextensible "gristle." The tightness experienced in the ITB actually emanates from the various muscles that attach to it.

The lateral knee pain associated with ITB syndrome occurs as the ITB rolls over the thigh bone toward the end of knee extension. Ordinarily the band glides over the bone with little resistance, aided by a sac of lubricating fluid called a bursa. In ITB syndrome, excessive pressure to the bursa causes friction, which leads to pain, swelling, and inflammation.

However, the causes of lateral knee pain are many and varied. The structures of the knee are poorly discriminated by the brain, meaning that pain can be felt in one place, but arise from somewhere else. Pain from the knee cap, cartilage, hamstring attachment, lateral ligament, and even arthritis can all be felt in the same vicinity as ITB syndrome. It is likely that this may lead many people to inadvertently believe they are indeed suffering from ITB syndrome.

The most frequent cause of ITB syndrome is faulty biomechanics. Poor hip and knee control increases the degree of friction as the ITB rolls over the outside of the knee, as well as tightness in certain muscles that attach to the ITB. In fact, faulty biomechanics put you at risk of a number of lower limb injuries.

Here's a quick test to see if you have faulty biomechanics. Stand on one leg, placing one hand on a wall or bench for balance. Perform a small squat, bending the knee 20 to 30 degrees. Now look down and see where your knee is. If it is aligned over your second toe, congratulations, you probably don't have a problem. If it points towards your big toe, or worse still, you can see daylight between your knee and foot, you may have a problem.

ITB syndrome can accurately be diagnosed with a clinical test by placing pressure over the bursa and bending and straightening the knee. Medical imaging such as MRI or ultrasound will confirm the diagnosis, with fluid being evident in the bursa of sufferers.

If you are diagnosed as having ITB syndrome, strengthening the glutei and hip rotators will improve hip and knee control. Although the ITB itself is inextensible, stretching or massaging tight muscles around the ITB may be useful.

If you are experiencing knee pain, you may be suffering from ITB syndrome. The answer may lie in correcting faulty biomechanics and weak glutei. However, there are many causes of knee pain, and a thorough examination by one of Pinnacle's physical therapists is essential to obtain the correct diagnosis. Then, our physical therapists at Pinnacle can design the appropriate rehabilitation plan for you.

Call Pinnacle Physical Therapy today! We have two locations - Post Falls (208) 777-4242 or Coeur d'Alene (208) 665-2000.