TLC for your ITB


COMMON CAUSE Usually a niggle at the outside of the knee translates to a physiotherapist as iliotibial band friction syndrome.

Andrew O'Brien

Now that the lockdown has eased, it seems the two most popular destinations for Irish people are Westport and the physiotherapy clinic.
The tourists are climbing Croagh Patrick, cycling the Greenway and going to the beach. The locals, on the other hand, are making appointments because they have ‘a bit of niggle at the outside of my knee’. Usually a niggle at the outside of the knee translates to a physiotherapist as iliotibial band friction syndrome.
To the non-runner, iliotibial band friction syndrome probably sounds like a contagious, and potentially fatal condition. Regular runners who have dealt with the dreaded ITB know that it can be much worse than that.
What starts as ‘a bit of a niggle at the outside of the knee’ can rapidly degenerate into a nasty pain that keeps you confined to barracks for weeks at a time and ruins training programmes at a blink.
But what is the ITB, and why does it cause so much dread in the running community?
The iliotibial band is described as being a fibrous strap that runs down the outer side of the thigh, from the hip bone to the outside of the knee, attaching into the top of the tibia. In university, physiotherapy students are taught that the ITB is non-contractile, and acts as a brace along the lateral thigh to stop our legs from collapsing under us when we walk and run. Pain, we are told, comes from a friction effect at the lateral condyle of the femur (the bottom of your thigh bone) when running.
Historically, it was believed that such friction occurred as a result of the knee buckling inwards when running. Conventional wisdom says that the knee buckles inwards either because your feet collapse inwards (known as overpronation) or the glute muscles are too weak to stabilise the pelvis. As a result, the normal course of treatment is to prescribe supportive shoes and orthotic insoles for the feet and strengthening exercises like the clam and single leg squat.
Sadly, for runners, and indeed for health professionals who treat them, research has shown that doing a single leg squat will improve a person’s ability to do a single leg squat, but does not necessarily change their running mechanics.
Similarly, the load produced during a side-lying clam exercise is nowhere near enough when you consider that impact forces when running are more than double your body weight. And as much as it’s a beautifully simple solution, there isn’t actually any evidence that supportive running shoes reduce your risk of injury.
What is the answer, then? Why is everyone I speak to complaining about pain at the outside of the knee? One part of the problem is overstriding. Many runners land too far in front of their body, meaning that the shock absorbers of the foot and ankle don’t work as well, and the knee has to deal with more than its fair share of the impact.
On top of this, overstriding results in longer than ideal ground contact times and increases knee joint torque, all major factors in injury risk. No single leg squat or new shoe can correct these things.  
The second part of the problem is usually a change in training load. Increasing mileage or intensity – or both – too quickly is a common factor in most running injuries. After a very quiet few months, September currently looks like it’s is going to be a busy one for races, and everyone is trying to get their mileage up quickly.
As usual, there is no magic bullet for ITB injuries. Typically, a combination of reducing the running load until symptoms to ease, a running specific-strength programme that addresses any local weaknesses and gradually builds both resistance and speed of movement, along with some running analysis to assess for issues like overstriding is needed.
If your knee is at you and that all sounds like it could take ages, fear not, most people with ITB can make a good recovery within four to six weeks. While the running load may be down, other exercises like cycling and swimming are great ways to cross train and keep the fitness up.
So maybe the tourists have it right – let’s all get the bikes out for a spin on the Greenway then go to the beach. After you’ve been to see your friendly local chartered physiotherapist, of course.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200
or at