Knee pain when running or cycling?
ITB syndrome

Knee pain is a common complaint with runners and cyclists and can be caused by the iliotibial band (ITB). Commonly this pain is on the outside of the knee, close to where the ITB attaches. If you think you have ITB syndrome and want to learn more, then read on:

Anatomy of the ITB

The ITB is a fibrous band that runs along the lateral aspect of the thigh originating at the iliac crest running over the lateral femoral epicondyle and inserting onto Gerdy’s tubercle at the tibia just below the knee joint line.

Symptoms of ITB Syndrome:

– Pain along the outside of your knee
– Pain that gets worse with exercise
– Pain for a few hours after exercise
– Pain on the push down of cycling
– Pain when running at down hills or certain angles
– swelling

Causes of ITB Syndrome:

ITB friction syndrome is an overuse injury of the outside of the knee and is not usually caused by direct trauma. Pain develops where the ITB courses of the lateral femoral epicondyle (LFE). It is common in runners and cyclists. The source of pain is debated – it was originally thought to be caused by friction of the ITB moving back and forth over the LFE. Other studies show that it could be attributed to the bursa, or innervated adipose tissue that is deep to the ITB or overuse tendinopathy as well as a range of anatomical and biomechanical factors.

Factors which could be causing your pain

• Weak hip abductors and gluteal muscles
• Running biomechanics
• Bow-legs
• Increased ankle supination
• Force of deceleration immediately after foot strike – weak biceps femoris
• Reduced ankle eversion and rear-foot pronation
• Calf muscle inflexibility
• Tight hip flexors
• Leg length discrepancy
• Other causes which mimic ITB syndrome

Common exercise factors which may cause ITB syndrome

• Running on a flat cambered surface or downhill
• Sudden increase in running mileage
• High weekly running mileage
• Running footwear that has a high heel height and width
• Over striding during running gait

Diagnosis and Treatment

There are many causes of ITB pain. It is important to be assessed by a physiotherapist who can determine what is causing your pain so that it is treated appropriately, and you can avoid long-term problems.

What can I expect when I see a Physio?

On your first session you can expect a thorough history and assessment where the Physiotherapist will work out what is causing your symptoms, and can work out a treatment plan from there. You may be advised a period of modified training load along with specific exercises to treat the underlying cause and then gradual return to full training. Your Physio will probably use manual therapy along with specific exercises in your treatment plan. Your Physio may analyse your running or cycling biomechanics later on once your symptoms have settled if needed. With proper assessment and treatment, you could expect a period up to 12 weeks of rehabilitation.

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