Iliotibial Band Syndrome

What is it?

The Iliotibial Band on a female skeleton

The Iliotibial band or ITB is a length of gristle-like tissue that runs as shown in the diagram above. It is very tough and unable to be stretched. As you can see, the band changes direction around a notch of bone. This is located where the buttock develops a dimple when you clench the gluteal muscles. Pain usually occurs at that point and can be located by pressing the area. If you can touch the painful spot, be reassured that it is not hip joint pain your hip joint is too far inside you to be touched. Pain can also occur in the hard strip you can feel on the outside of your thigh or where the band starts or finishes as shown above. This problem is also frequently misdiagnosed as sciatica or referred pain. Sciatica is in the rear of the buttock / thigh. This pain is in the side of the thigh. It is not referred from the back. Pain will occur while walking, while lying on the affected side in bed and often while lying on the other side, if the sore leg is allowed to touch its knee to the bed. You may have learned you can sleep best with a pillow between the knees.

What makes it painful?

In females, the notch of bone labeled the greater trochanter is much more prominent. This makes the angle greater to start with. In pronators (people whose feet roll in), not only are the feet affected but the whole leg will rotate inwards (towards knock knee). This further increases the angle and increases the distance between the start and finish of the band by up to 6 mm. As the band cannot stretch, this makes it very tight and presses the band against the bone. Between these two structures is a small fluid filled sack called a bursa not unlike an oversized jelly-bean. Too much pressure will cause it to become inflamed (called bursitis) and painful. Men are far less likely to be afflicted but often have a severe case if they are.

What can be done?
As described earlier, the band is made of completely unstretchable retinacular fibres. Massage is very painful and of no benefit. As the bursa is a self-contained sac of fluid, it has no significant blood supply, explaining why nearly all antiinflammatory medications don t work. Codeine, which acts within the brain, is the exception and will supply some short term relief but may be detrimental to the digestive tract in the long term. Topical anti-inflammatory rubs cannot penetrate the thick gristle to reach the inflamed bursa below. Physical methods of reducing inflammation such as heat and ultrasound will help until the area is irritated by the next day s walking again. Happily, this condition responds very well to a simple treatment. Using custom made plates called orthotic devices that go into your shoes, we can stop the excessive foot pronation and limit the amount of internal rotation occurring in the leg. This will return the band to the correct length and stop the excessive pressure on the bursa. This rotation is quite difficult to control, needing perfectly fitting orthotics and for this reason one-size-fits-all insoles from sport shops or chemists are not suitable.