Question regarding treatment of Iliotibial Band Syndrome

A Massage therapist from Richmond Hill, Ontario, Canada asked:

“Dr. Spina – I have a patient with a very “stubborn” case of Iliotibial Band Friction Syndrome. She has had it for approximately 4-5 months now, and my treatment does not seem to be getting to the root of the problem. In fact, often she describes an increase in symptoms following my treatments. What do you think?”

Answer: This is actually a common problem amongst my students who also struggle with treating cases of the so called Iliotibial Band “Friction” Syndrome. For those who are not in the medical field, the Iliotibial Band, or ITB, is a fibrous structure which starts at the lateral aspect of your pelvis, and inserts into the lateral (outside) and anterior (front) aspect of your knee. It is a common cause of lateral knee pain in runners and it was believed that the cause of the pain was due to the fact that the ITB “rubbed” along the outside of the femoral condyle (the thigh) during running (with the knee at the 30 degree range); hence the term “friction”. A recent study however has demonstrated that this is in fact not the case, and that the problem is not one of increased friction at all. Fairclough et al. (2006) published a study in the Journal of Anatomy which demonstrated that the ITB does not rub along the outside of the knee at all. It is actually tightly adhered to the lateral aspect of the femur. Thus the assumption that friction is the root of the problem is in fact incorrect. What they found is that deep to the ITB in the area of the knee, there is a prominent fat pad. When the knee is at the 30 degree range, the ITB actually compresses tightly along the femur thus irritating the fat pad in symptomatic patients. Thus the problem is not one of friction, but one of inflammation. Therefore treatments, such as aggressive massage, in the area of the fat pad will only serve to irritate the condition. Therefore my advice would be to aggressively treat/stretch the entire ITB except for the area where the symptoms are. This will serve to “loosen” the structure thus decreasing the amount of compression experienced at the 30 degree range. The actual area of pain should be treated as an inflammatory condition requiring ice, anti-inflammatory meds, and other anti-inflammatory modalities. In terms of rehab, Fredricson published a paper outlining the importance of strengthening the hip abductors for resolving this condition (which would improve the lateral stability of the patient).

Dr. Spina