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What is Iliotibial Band Pain?

What is the iliotibial band (ITB)?

The ITB is a very strong structure which is confusing as it is not definitively a tendon, ligament or just a dense fibrous connective tissue. In reality it is all three. It is a tendon by definition because it connects a muscle, the tensor fascia lata, to bone. It is a ligament because it connects bone to bone and limits unwanted movement to provide stability. And it is made of dense fibrous connective tissue.

The ITB is not only connected directly to bone but also to the surrounding muscles via further connective tissue. It connects to the gluteus maximus, quadriceps, hamstrings, gastrocnemius muscles and connective tissue around the patella (knee cap). So the state of all of these muscles can have an impact on the compressive forces of the ITB.

What are the symptoms?

Pain usually develops quickly during or after a particular activity. It is usually felt initially as a sharp pain on the outside of the knee that will often worsen if the activity is continued. The bony prominence on the outside of the femur bone just above the knee is where symptoms are most commonly felt. It is at this point that the ITB can get compressed against the bone. With the highest compression when the knee is bent to 20-30 degrees.

What causes ITB pain?

There is a small fat pad that sits between the ITB and this bony prominence to protect the soft tissue from the hard bone. It is this structure that becomes painful and inflamed with repeated compression, not the ITB that is actually causing pain.

ITB pain is very common in runners. However, it can occur after excessive or unusual down-hill walking and occasionally cycling. It can usually be linked with a change of type of exercise, intensity or volume. Contributing factors include poor muscle recruitment or weakness around the hip joint, running biomechanics, foot posture and fatigue. Therefore, ITB pain is very common with first time half or full marathons runners.

Myths

The first myth to bust is that this condition is caused by friction and it is sometimes call ‘Iliotibial band friction syndrome’. The band cannot move back and forwards therefore no fiction occurs. The issue is related to compression and inflammation of the fat pad.

Second myth to bust is that stretching, foam rolling or massaging the ITB will help. The ITB is an immensely tough structure and it will not be loosened or lengthened by foam rolling it.

 

For some helpful tips please read “How to avoid injuries or manage them during your marathon training“.

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Very knowledgeable physio Team! Was in London on a business meeting and ended up visiting James for some urgent treatment on my lower back. Delighted with the service. James put me at ease straight away. His treatment was paramount in getting me through what was a hectic weekend. Could not recommend enough. Will definitely be back when in London again!
Funky Inflatable Co.
Funky Inflatable Co.
17:29 11 Sep 18
Went to "Flawless Physio" two weeks ago for back pain that I'd been carrying for months. Three sessions later, it's all gone! The staff was very pleasant, professional and gave me a series of simple exercises to do at home. I definitely recommend them. I'll be back, hopefully not too soon ;)
Charles Muzard
Charles Muzard
13:04 24 Sep 18
I was recommended to see James by my consultant following surgery to my ankle. He was extremely professional and knowledgable. He motivated me throughout the process and I have now returned to long distance running thanks to his help. I would recommend his services to anyone
David Burns
David Burns
19:32 08 Sep 18
Awesome team. I ended up having to seek out treatment when my back went into spasm (on going problem) whilst down visiting friends. I saw James and he was very professional and through with his treatment. More importantly he gave me a better understanding about what was going on and how to manage my injury in the future. Highly recommended!
James Tatham
James Tatham
08:03 20 Sep 18
I received treatment from Vicky for a very stiff and painful neck, possibly brought on by tension. I felt confident that my therapist was knowledgeable. The service was very friendly and professional and I felt good progress from the first session already. Vicky recommended some exercises and explained how to do them with very clear diagrams and instructions. I would highly recommend Vicky
Tiziana Guffanti
Tiziana Guffanti
17:23 29 Aug 18
I would highly recommend Flawless Physio. Excellent knowledge/treatment and also brilliant customer care - following up and giving advice. Tailored rehab to suit the type and level of sport as well as lifestyle. My wife & I have been treated by both James & Victoria and they have both been great. Will continue to use for any future injury & rehab.
Joe Gomes
Joe Gomes
19:11 30 Mar 19
I saw Victoria for my dodgy shoulder, and she was brilliant. Very professional And knowledgeable, she really took time to explain what was going on and to treat it. She followed up with me to check I was getting on well with the exercises. She is also really accommodating with timings for appointments. I couldn't recommend more highly, thank you Victoria!
Fiona Hall
Fiona Hall
08:35 27 Mar 19
First class. Had 4 or 5 appointments with Victoria that were always late in the evening, although you wouldn't know it. She took her time, whether that be on soft tissue work, explaining how to do an exercise, or the purpose behind it. A genuine person that wants to help and she clearly knows her stuff.
Jamie Moles
Jamie Moles
21:14 20 Jan 19
Went to flawless physio and vic was great! Training for a marathon and she was very understanding and helpful. Living in the Twickenham area so was in great location! Her specialist knowledge in knee injuries was able to get me back running in two weeks 🏃🏼‍♀️
Ruth Herlihy
Ruth Herlihy
23:44 25 Jan 19
I injured my leg (ITB) training for the Berlin Marathon and then made it far worse it by trying to run it. Victoria has been essential in my recovery, helping me understand how to strengthen the right muscle groups and get back to running. I have been very impressed by the depth of knowledge and insight. This weekend I will run the Cancer Research 10km. Thank you!
Paul Carpenter
Paul Carpenter
17:02 28 Jan 19
Really impressed with the service provided at Flawless Physio. Vicky was knowledgeable, professional and her invaluable treatment and advice got me to the start of this year’s marathon when I’d had to stop running with 8weeks to go. Without the advice and care I received at Flawless Physio, at best I’d have limped my way round the course and at worst, not been able to take part at all. Definitely recommend!
Katy Gomes
Katy Gomes
11:03 30 May 19
James helped resolve a hamstring injury that had troubled me for the best part of a year. I'll certainly use Flawless Physio for any future issues. Highly recommended.
Sandeep C
Sandeep C
18:02 30 Apr 19