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  • Dori Nissenson

Summer Series - Part 4

Summer Sailing On

As the summer rolls on, I continue to see more exercise-related injuries in my practice due to changes in exercise frequency, intensity, and environment. These changes can lead to joint and muscle pain, preventing us from enjoying our favorite summer exercise and sport routines.

This letter of my summer series will focus on Iliotibial Band Syndrome.

The iliotibial band is a connective tissue band that runs along the outer aspect of the thigh from the pelvis to the tibia, crossing both the hip and knee joints. The ITB stabilizes the outside aspect of the knee joint as it flexes and extends during movement.

ITB syndrome is an overuse injury that is caused by the continual rubbing of the band over the lower aspect of the femur or the thigh bone during this repeated flexion and extension of the knee joint. Many of the sports that we participate in during the warmer months such as running, biking, hiking, tennis, and swimming involve this repetitive flexion and extension of the knee joint. In addition, exercising outdoors on uneven terrain can add to stress at the knee joint during this repetitive motion. Pain and inflammation then result at the knee joint, impairing our ability to participate in our favorite summer activities.

How Do You Know If You Have ITB Syndrome???

ITB syndrome is easy to diagnose. Seek care right away to avoid a lapse in activity.

Typical Symptoms Of ITB Syndrome Are:

1. pain on the outside of the knee joint which may begin as a stinging or needle-like pricks that are often ignored…. this usually progresses to pain every time the heel strikes the ground during most physical activities

2. a snapping or popping sound at the knee joint

3. swelling where the band crosses the outside of the knee joint or below the knee where it attaches to the lower leg

4. pain radiating along the course of the ITB at the outer thigh from the hip to the knee

What Causes ITB Sundrome???

ITB problems are usually the cause of a combination of issues including poor exercise/training habits, poor flexibility of muscles, decreased isolated gluteal muscle strength and mechanical imbalances in the body involving areas such as the low back, pelvis, hips and knees.

Training Errors: Training errors such as always running on the same side of the street or increasing one’s mileage too quickly may cause athletes to develop iliotibial band syndrome.

Tight Muscles: Tight piriformis, hamstring and quadricep muscles will cause more snapping of the ITB over the outside of the knee joint.

Alignment Issues: Athletes with a leg length discrepancy are especially susceptible to developing ITB syndrome because the pelvis has to tilt to accommodate the leg length difference and this puts stress on the ITB.

→ Those who are bowlegged are also at risk for developing ITB syndrome. This type of leg alignment will cause the ITB to become excessively tight.

→ Athletes who are over pronators are at risk for alignment issues up the leg that could potentially cause ITB syndrome.

How Is ITB Syndrome Treated???

If you think you may have iliotibial band syndrome, it is imperative that you seek the help of a physical therapist.

A program of physical therapy should be initiated immediately and will include:

1. manual soft tissue and joint mobilization to reduce pain and release the tight band at both the hip and knee joint

2. stretching of tight musculature in the leg that may be contributing to the diagnosis

3. strengthening the muscles of the leg to decrease the stress on the iliotibial band. Specifically, the gluteal muscle group and the hamstrings as weakness in these two muscle groups may cause stress on the ITB

4. manual adjustment of the alignment in your pelvis or legs to eliminate any causes of the ITB syndrome related to bony alignment

5. shoe recommendations to maintain good alignment of your feet on the ground and prevent overpronation of the feet which can cause ITB syndrome

6. orthotic fabrication to maintain good foot alignment when exercising

7. education and safe exercise guidelines such as:

  • making sure your feet are a bit of a distance apart when exercising which will alleviate stress on the ITB

  • increasing your exercise intensity slowly

  • limiting the amount of downhill running and jumping that you are doing


The inflammation can cause scarring in the knee joint and decreased knee joint range of motion which can seriously affect one’s ability to exercise without pain.

If caught early enough, ITB problems can be dealt with quite easily allowing a safe return to our favorite summer activities!


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