What is ITB Friction Syndrome (Runner's Knee)?

You often hear people talking about 'roll out their ITB.' However what does that actually do and what is your ITB? In this blog we provide some clarity about your ITB, ITB friction syndrome and how you can treat it. 

What is your ITB? 

Your ITB or Iliotibial band is a piece of connective tissue known as fascia. It runs from your pelvis (Ilium) and inserts into the side of your lower leg bone known as your tibia, hence the term 'Iliotibial Band.' The ITB and the muscles associated with it (your TFL and Gluts) assist in knee stability when you walk or run. 

When you look at the side view of the leg you can also see how close the ITB is to your Vastus Lateralis, one of your quadriceps muscles and your Biceps femoris, one of the muscles that make up your hamstring. That is why when we are massaging a person we suspect has ITB friction syndrome we target these muscles. 

What is ITB Friction Syndrome

There is a common misconception that your ITB is 'tight.' It is a piece of connective tissue and its role is to stabilise the knee. It needs a certain amount of tension to do its job. It is the muscles around it and that insert into it that get tight.

​When you bend your knee to 30 degrees your ITB slides across a bony protuberance (area) called your femoral condyle. With altered biomechanical function or any number of the factors described below, it can cause excessive friction of the ITB over the bone. This can lead to irritation, pain and/or inflammation in the area known as ITB friction syndrome. 

These changes can be from a variety causes:

• Weakness in certain muscles such as your gluts or inner quad muscle (Vastus Medialis),
• Poor running style,
• Tightness in muscles like your quads, TFL, hamstrings, gluts, lateral calf,
• Altered training load including increases in duration/ intensity or running hills,
• Your running shoes 
• Or a combination of several of these. 

The key is to work out which of these are contributing to the excessive friction and correct them - which is where allied health professionals such as massage therapists, physios and exercise physiologists can help. 

What are the Symptoms of ITB Friction Syndrome?

• A sharp pain or burning sensation on the outside of your knee
• Swelling 
• Increased pain when you run or during the early stages of bending your knee such as into a squat.
• Gradual onset over several weeks
• Pain that worsens when continuance of repetitive exercise - such when you are on a run the only way to get the pain to stop it to stop running.

What are the Treatment Options? 

• Length - Remedial Massage or Myotherapy
  Your remedial massage therapist or myotherapist will assess what is going on and address any tightness in the area that is increasing the load on your ITB, contributing to the friction. This usually means they will release your TFL and Glut Muscles with deep tissue massage, trigger point therapy or dry needling, since they insert directly into your ITB. They will also look at your quads, hamstrings and lateral calf muscles are these are known to help relieve the symptoms of ITB friction syndrome. 

• Adjust Biomechanics and Running Form - This can involve a combination of physio, exercise physiology and/ or massage therapy to correct the way your joints move and how you run. We like to have a combined approach to your treatment and can make recommendations on who to see specifically for this condition.

• Strength - Weakness in your gluts is commonly associated with ITB friction syndrome. Your massage therapist, physiotherapist or exercise physiologist can have a look and assess whether or not strength is something that you need to address to help with this condition


• Adjust Your Load - Training load plays an important role this condition due to the repetitive nature of running. It is important to have a look at your training load - how quickly you have built up your running or training, what intensity you are training at as well as the amount of rest/ recovery you are giving yourself between sessions. 
  
  
• Self Massage and Stretching - Yes! We know we harp on about these!! We find self massage through triggering of your TFL and gluts, foam rolling through your quads and stretching your hamstrings a good way to help with this condition. You could 'roll out your ITB.' However by doing this you are just loosening off your lateral quads, hamstrings and TFL. Like we said early these all attach into IT and your ITB is fascia, which can't really be stretched or loosened. Also, if the area is already irritated and you try to put all your body weight directly on top of it can you see how that might not be the best idea!? That we why we recommend addressing all the areas around it and leaving the area of irritation alone. 

For more information on this condition or to book in feel free to get in contact with us and we can point you in the right direction of who to see and how we can help through massage.