Iliotibial Tibial Band Syndrome (ITBS) is a common injury that affects triatheletes, runners and cyclists.   Using conventional treatments, this condition never completely resolves since these treatments typically do not address all of the key structures involved in the injury.

ITBS presents as:

   A sharp or burning pain on the lateral aspect of the knee.

   Pain radiating up the side of the hip or thigh.

Vancouver International Marathon

When the ITB is shortened or stressed, the repetitive motion of the knee causes friction and inflammation of the iliotibial band.

   When the knee is flexed at an angle greater than 30 degrees, the iliotibial band moves back behind the lateral femoral epicondyle.

   During knee extension, the ITB shifts forward in front of the lateral femoral epicondyle.

With ITBS, the bursa often become inflamed, causing a clicking sensation as the knee flexes and extends.

Common causes of ITBS in cyclists include:

    Poor cleat position cause
ITBS when cleats are excessively rotated internally.
The feet should feel straight when clipped into the pedals, with no torsional or twisting stress occurring when you are pedaling.

    Incorrect saddle height.
The saddle height should be set so that your legs are almost fully extended at the bottom of each pedal stroke. Keep the following points when adjusting saddle height:

    Your hips should not rock back and forth when pedaling. If they do, lower your saddle.

    If the saddle is too high, you will have to stretch your legs too far to reach the bottom of the pedal stroke.

    Poor saddle positions.
Bike saddles that are positioned too far back cause a tightening of the ITB by forcing the cyclist to reach for the pedal with each stroke.

    High gearing ratios.
This may cause excessive generation of force by the ITB.

    Excessive hill work.
It is important to gradually increase hill work to avoid stressing the ITB.

Cyclist at the Penticton Ironman

Common causes of ITBS in runners include:

  Running on slanted surfaces such as a circular track.

  Excessive downhill runs.

  Increasing mileage or pace too quickly.

  Weak knee flexors and extensors.

  Weak hip abductor causing excessive internal rotation of the knee.

  Weak gluteus medias causing internal rotation of the thigh.

  Pronation causing internal rotation of the knee.

  Bow legs (Genu Varum).

  Leg length discrepancy.

   Biceps Femoris

  Capsule

  Collateral Ligaments

   Gastrocnemius

   Gluteus Medius

   Knee Capsule

   Meniscus

   Patellar Tendon

   Peroneus Longus Muscle

   Popliteus Muscle

   Psoas muscle

   Vastus Lateralis

From Primal Pictures

Copyright Dr. Mike Leahy

Chronic irritation to the iliotibial band leads to small tears within the ITB. This produces an inflammatory reaction.

Once the inflammatory condition has started, even simple tasks such as walking can put considerable internal pressure on the ITB.

This constant internal pressure limits circulation to the tissue, resulting in decreased delivery of oxygen to soft tissues. Decreased oxygen causes several biochemical changes that result in the formation of yet more adhesions within the ITB.

This in turn creates more restrictions, inflammation, and swelling.

The body responds to inflammation by laying down additional scar tissue (cross fibers across the tissue) in an attempt to stabilize the affected area. This scar tissue:

   Restricts motion.

   Reduces circulation.

   Inhibits nerve function.

   Causes ongoing friction and pressure.

   Results in the production of yet more cross fibers and adhesions across inflamed soft tissues.

To truly resolve ITBS, every structure that crosses the lateral side of the knee must be evaluated and treated. In addition to the ITB, the practitioner must also evaluate and treat the muscles, ligaments, meniscus, and capsule.

Once this is done, the hip itself must be corrected to remove the root cause of the problem.

Unfortunately, it is common for this condition to never fully resolve, since practitioners rarely evaluate and treat ALL of these structures.

With ART, resolution can be seen in over 90 percent of ITBS cases, within 4-6 visits.

Effective treatment of the ITB, or of any soft tissue injury, requires an alteration in tissue structure to break up the restrictive cross-fibre adhesions and restore normal function to the affected soft tissue areas. When executed properly, this process substantially decreases healing time, treats the root cause of the injury, and improves athletic performance.

Active Release Technique (ART^®) is very successful at treating this type of injury since it removes restrictive adhesions between both the superficial and deep tissue structures along the entire kinetic chain.

The first step in treating this condition is to perform a biomechanical analysis of the athlete to determine where the restrictions are located along the entire kinetic chain.

ART treatments are specific and based upon the individual needs of each athlete. It is not a cookbook approach to treating a non-specific diagnosis.

ART finds the specific tissues that are restricted and physically works them back to their normal texture, tension, and length by using various hand positions and soft tissue manipulation methods.

Dr. Abelson treating ITBS at the Ironman Kona

With ART, we often see immediate improvement after we identify and work with the damaged structures.

Dr. Brian Abelson is Clinical Director of Edgemont Chiropractic Clinic. Dr. Abelson is a native Calgarian who graduated from Palmer College of Chiropractic West with an award for clinical excellence, holds a Level 3 Active Release Certification, and is an ART Assistant Instructor. He is also the author of the award winning websites: www.drabelson.com and www.activerelease.ca .

Author: Dr. Brian Abelson DC, ART

Editor: Kamali Abelson, Rowan Tree Consulting Ltd.

Edgemont Chiropractic Clinic

Bay #10, 34 Edgedale Drive N.W.

Calgary, Alberta, T3A-2R4