Updated: Feb 11
Lateral knee pain is a common complaint in running sports with the ITB (Ilio-Tibial-Band) contributing up to 14% incidence in a knee injury. The Ilio Tibial Band connects the top of the hip bone (iliac crest) to the outside of the knee joint at the femoral condyle and tibial condyle. Upper fibers at the hip connect to the sacrotuberous ligament, ischial tuberosity, and the pubis. Lower fibers at the knee merge with the patella retinaculum. Deep fibers form inwards to the linea aspera of the femur. This provides an incredibly strong link between the hip and knee for stability when standing requiring little muscular involvement. Three muscles attach into the ITB, the gluteus maximus, gluteus medius to the posterior, and the tensor fascia lata to the anterior portion. The ITB is involved in early gait to stabilize and control the knee and pelvis and in later gait in hip extension. It is commonly believed that ITB pain is caused by friction over surrounding structures but newer research suggests this is a compression injury caused by the excessive tension over the band insertion and surrounding structures.
Testing involves assessing for muscle function and endurance together with an indication of compensatory movement patterns. Trendelenburg test and the Obers test are two tests used to indicate which tissue is involved and where any compensation occurs and guides our treatment.
Sets and reps: during early rehab we are looking for neuromuscular function rather than strength so low weight slow holding patterns are used. Late-stage we add weight to fatigue muscles in order to build strength, not bulk.
Rehabilitation of Ilio Tibial Band
Rehab work would begin with open-chain exercises to promote inner range holding endurance for hip abduction and external rotation. Exercises such as the clamshell and scissor leg lift are used as primary movements in isometric, concentric, and eccentric control. Slow lift to hold and then slow lowering to resting position. We are aiming for 10 repetitions taking 8-10 secs to complete each rep, once we have reached this pain-free we progress on to phase 2 of rehab.
We begin phase 2 by moving to closed chain weight-bearing exercises working on maintaining stability and control of the pelvis. It is essential to avoid hip drop and knee internal rotation. Using some visual and verbal cueing to help perhaps by performing these exercises in front of a mirror may help with this. Progress is monitored by time to fatigue and control of movement.
Phase 3 moves on from phase 2 by combining classic movements like squats, lunges, and deadlifts with open chain resisted movements. Weight is now added to progress with 6-8 reps to fatigue and minimal reps in reserve. Reintroduction of running/walking now becomes part of the final phase of rehab and a gradual return to sport.
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