The iliotibial band (ITB) is a broad and thick tissue that runs along the outside of the thigh. It is a passive stabilizer of the hip and is the attachment point for multiple muscles. Due to improper mechanics the ITB can become overly stressed and lead to inflammation and irritation. This typically occurs at the knee or hip, but can occur anywhere along its path. An injury to the ITB can cause difficulty with daily activities, and can even cause pain when attempting to sleep. The more you know about prevention and the cause of your injury, then the better the chances are you can avoid another episode.
There is a lot of complexity in determining the cause of pain in the ITB. When considering what may have led to an increase in pain it may be helpful to break it up by internal and external factors. There is typically more than one thing at play so a thorough assessment is key to starting a successful recovery:
- Internal Factors – Poor flexibility in the hip or thigh, weak gluteal musculature, tightness in the ITB, poor mechanics with running and/or lifting.
- External Factors – Improper footwear, improper orthotics, change in training intensity, change in training surface, or sudden increase in activity level.
Pain in the ITB can come from any one of these common conditions:
- Trochanteric Bursitis – This is often caused by increased rubbing of the ITB over the bursa on the outside of the hip. Pain with this diagnosis can travel the length of the ITB and even down into the lower leg/calf. This can be caused by overuse or from a traumatic fall landing on the outside of the hip. Rest, stretching, and activity modification are key initial interventions to relieving the symptoms.
- ITB Syndrome – This is a common injury in runners, but can plague anyone. The direct mechanism of the pain is increased wearing and rubbing of the ITB over the bony parts of the leg bones. Running and lifting mechanics are often poor and need to be addressed to decrease risk of pain returning.
- Knee or Hip Pain – Sometimes the pain can be vague and unclear, and manifest itself as general pain on the outside of the hip or knee. This is often an overuse injury that starts slowly, but can build to a debilitating level. Often there are a couple of the factors listed above that are impacting mobility and symptoms.
- Lumbar Spine Radiculopathy – Pain in the ITB could be coming from the low back and this is known as radiculopathy. This is difficult to tell apart from the other conditions above, but is often accompanied by numbness/tingling.
Some leading tips to help prevent and rehabilitate ITB injuries include:
- It’s So Tight! – The ITB does not stretch, but the muscles around it do! So make sure to stretch your quads, hamstrings, and gluts daily. Ask your PT how!
- Listen to Your Body – When increasing your activity level start with small increments and pay attention to how your body responds 1-2 days after the activity.
- I’m on a Roll! – To help loosen up a tight ITB you may want to try rolling it with a foam roller.
If you have pain in the side of your thigh that isn’t going away, rehabilitation is a great step to take to improve your functionality. During rehabilitation:
- Balance It Out – Focusing on strong hip musculature will help to decrease stress and balance pull on the ITB.
- Which is it: Hip or Knee? – The ITB crosses both the hip and the knee, and can cause pain anywhere along the outer thigh.
- So What is the Problem?!? – Pain in your ITB is usually caused by an imbalance somewhere else in the body. Proper treatment to the foot, ankle, knee, hip, and core may be needed to aide recovery.