Physio Management of ITB Syndrome

What is ITB Syndrome?

Iliotibial Band (ITB) Syndrome is a condition that results in pain on the outer side of the knee, often experienced by athletes who engage in repetitive activities like running or cycling. The ITB is a thick band of connective tissue that runs along the outside of the thigh, from the hip to the shin, and plays a critical role in stabilizing the knee during movement. The ITB is an extension of the tensor fascia latae, gluteus medius, and gluteus maximus.

When the ITB becomes tight or irritated, it can lead to friction between the band and the lateral epicondyle of the femur. This friction can cause inflammation, resulting in lateral knee pain, particularly with activities that involve repetitive periods of knee flexion and extension, like running or cycling.

The ITB is in contact with the lateral epicondyle at about 30 degrees of knee flexion—which is around the angle your knee makes when your foot strikes the ground while running or cycling. This is known as the ‘impingement zone,’ and this is why activities that involve repetitive knee flexion can trigger ITB Syndrome.

Symptoms of ITB Syndrome: 

• Pain on the outside of the knee

• The pain gets worse with activity—the more you run or cycle

• Pain may radiate up or down the thigh and shin

• Clicking or popping sensation

How is ITB syndrome treated?

Fortunately, most cases do really well with conservative management, and patients will have a complete resolution of symptoms within 6-8 weeks. A combination of the following approaches is often recommended to manage and alleviate symptoms:

• Manual therapy to loosen the muscle attachments to the ITB (glutes, TFL)

• Strengthening of the hip abductors

• Gradual return to activity

Return to running:

• Gradual return to running on a flat surface

• Run at a relatively fast pace—don’t try to return to running at a slow pace

• Avoid downhill running

Running on a flat surface and at a fast pace has been shown to reduce time spent in the impingement zone- the time that the ITB is in contact with the lateral femoral epicondyle.

Examples of exercises to strengthen hip abductors: 

• Side-lying hip abduction holds

• Side-lying leg lifts

• Modified side plank + leg lifts 

• Banded crab walks

• Single-leg squats

• Banded glute bridges 

If this sounds like you, book in with a trusted physiotherapist at Lilydale or Healesville Physio & Sports Medicine for an individualised treatment plan. 

Example photos of exercises to strengthen hip abductors: 

Eg. Side-lying hip abduction holds

Eg. Side-lying leg lifts

Eg. Modified side plank + leg lifts 

Eg. Banded crab walks

Eg. Single-leg squats

Eg. Banded glute bridges 

References: 

Hadeed, A., & Tapscott, D. C. (2019). Iliotibial band friction syndrome. 

Balachandar, V., Hampton, M., Riaz, O., & Woods, S. (2019). Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscles, Ligaments & Tendons Journal (MLTJ), 9(2).

Common myths during pregnancy

There is so much noise when it comes to what you should and shouldn’t be doing to have a healthy and active pregnancy, that it can be hard to tell what’s true and what is a myth.

We’re here to bust some common myths for you, and offer some advice about what things youcan do to have a healthy and active pregnancy.

Myth 1: You need to keep your heart rate below 140bpm when exercising.

NOPE! You do not need to keep your heart rate below 140bpm when exercising. In fact, the Australian Government Pregnancy Exercise Guidelines actually recommend vigorous activity for 1.25-2.5 hours per week whilst pregnant.

What is vigorous activity? It is activity where you are unable to talk whilst completing it because you are huffing and puffing, such as jogging, cycling, or swimming at a decent pace.

A better method of monitoring yourself whilst exercising is using the Rating of Perceived Exertion scale (RPE). This is a scale from 1-10, where 1 is easy, and 10 is flat out and could only sustain for a couple of minutes. During pregnancy Exercise & Sports Science Australia (ESSA) recommend sticking to 6-7 RPE or less during pregnancy.

Myth 2: Pregnancy hormones like relaxin make the pelvis loose and unstable and that’s why we get pelvic girdle pain.

WRONG! The pelvis stays strong and stable during pregnancy. Besides, if relaxin makes our pelvic ligaments unstable, why do some women remain pain free during pregnancy?

The reason some women develop pelvic girdle pain during pregnancy is complex, and more to do with the pelvic area becoming more sensitive during pregnancy.

Because our body is protecting our baby, it becomes more sensitive to changes in the area such as tight lower back muscles, tight glutes, or weakness in muscles that can cause pain.

There is also a link between pelvic girdle pain and incontinence, and a link between pelvic girdle pain and stress at work (Pulsifer et. al, 2022).

It’s recommended to seek help early, ideally within the first 2 weeks of pelvic pain occurring, as research shows that if you do this then you have a higher likelihood of the pain completely resolving.

Myth 3: It’s normal to leak urine during or after pregnancy.

It is COMMON, not normal. The Continence Foundation of Australia (2024) estimates that 1 in 3 women who have a baby will wet themselves at some point in their lives, so this is an extremely common occurrence.

However, leaking is not normal and there is something you can do about it - pelvic floor exercises!

How to squeeze your pelvic floor muscles: squeeze the muscles around your anus as if you are holding in wind. Studies have shown that this cue is the most effective for the majority of people.

Try starting with 10 x 2-3 second holds completed three times a day, and slowly build up to 10 x 8-10 second holds three times a day.

If you’re not sure that you’re doing your pelvic floor exercises correctly, book in to see a women’s & pelvic health physiotherapist for an assessment.

References:

Continence Foundation of Australia (2024). Pregnancy, childbirth and incontinence. Retrieved from: https://www.continence.org.au/incontinence/who-it-affects/women/pregnancy-and-childbirth#:~:text=Many%20bladder%20and%20bowel%20problems,or%20do%20exercise%20(stress%20incontinence)

Department of Health and Ageing (2021). Physical activity and exercise during pregnancy. Retrieved from: https://www.health.gov.au/topics/physical-activity-and-exercise/pregnancy

Pulsifer, Jodie & Britnell, Susannah & Sim, Adrienne & Adaszynski, Jessica & Dufour, Sinéad. (2022). Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. British Journal of Sports Medicine. 56. bjsports-2022.10.1136/bjsports-2022-105724.

Hip bursitis? How your physio can help!

Bursitis is part of a cluster of hip problems that are known as greater trochanteric pain syndrome (GTPS). This is the fancy name for pain on the outside of the hip, that usually involves the glute muscle tendons, and the hip bursa.

The bursa is a fluid-filled sack that sits underneath the glute muscle tendons, and helps them to glide smoothly over the bone on the side of the hip.

Bursitis is when the hip bursa becomes inflamed and swollen, causing pain to the outside of the hip.

How does GTPS occur?

GTPS usually occurs because the hip stabilising muscles (gluteals) have become weak, which causes a change in the hip tendon structure known as tendinopathy. Tendinopathy can be painful on its own, but often causes bursitis as it can cause compression and irritation of the bursa.

GTPS can also be triggered by hormonal changes such as menopause. Menopause causes the tendons in the hip to become more brittle or less flexible, and more prone to developing tendinopathy and bursitis.

Most of the time it is a combination of the two that causes the problem.

Treatment for GTPS

1. Reduce / modify aggravating activities: try to keep pain 3/10 or less to settle the tendon down.

2. Strengthen the glute muscles- start with isometrics (holds against resistance) and slowly increase to functional movements, such as sit to stand and squats.

3. Do not stretch- this will aggravate tendon pain. Instead use a spikey massage ball to loosen up your glute muscles, and a heat pack can help as well.

Help! It’s not getting better!

If you need additional support, see one of our friendly physiotherapists for a thorough assessment and treatment plan for individualised management.