The majority of running related knee pain at COR is lateral knee pain. Often the pain is non-painful throughout the day, but painful after 10 – 20 minutes of running. This knee pain could be a wide range of problems, but is likely iliotibial band syndrome. Iliotibial band syndrome is the second most common running injury. It is the main cause of lateral knee pain in runners and accounts for approximately one tenth of all running injuries. An increase in Iliotibial band syndrome was noted over the past decade and may be related to the increasing number of runners worldwide.
Many runners are tough cookies, believing they can fix this problem on their own. The self treatment typically involves taking anti-inflammatory medication, rest, and running volume modification. This self-treatment can help the problem, but this method doesn’t typically fix the actual problem. Iliotibial band syndrome is a complex issue with the cause stemming from many areas. The cause may also be from multiple areas, the last thing a runner training for their first 1/2 marathon wants to hear…
Understanding the cause of the Iliotibial band syndrome is mandatory for a successful recovery and future prevention plan. Here are 7 causes of Iliotibial band syndrome:
8 Causes of Iliotibial Band Syndrome
1. Excessive Friction on the Lateral Femoral Condyle: Excessive rubbing can cause irritation and pain. While running, the Iliotibial band moves over the outside of the knee (the lateral condyle). This excessive rubbing can cause stress and fail with tissue overload. This tissue overload can result in an injury. This injury mechanism is the traditional thought of 7 causes of Iliotibial band syndrome (Khaund 2005).
2. Impingement of the Iliotibial band: A more recent theory of the cause is impingement of the Iliotibial band against the lateral femoral epicondyle at approximately 20-30° of knee flexion (Fredericson 2006). This cause may sound like the first point, but is quite different as an impingement occurs when a tissue is actually trapped during a hard surface, not simply from rubbing.
3. Leg Length Differences: Anatomical factors such as leg length differences can also cause Iliotibial band syndrome (Khaund 2005; Orchard 1996). If a runner has a longer leg, each time they land, one leg (typically the shorter leg) will land more under the body, increasing stress on the Iliotibial band.
4. Bony Differences: Although we all think we have the same bony structure, anatomical differences exist between humans. These differences are similar to a big nose, so people have a bigger nose than others. Some people have a larger lateral epicondyle which can increase rubbing and stress, life isn’t fair 🙁 (Fredericson 2005)
5. Muscle Weakness: Weakness at the core and hips (specifically the glutes) can impair running biomechanics and increase stress at the Iliotibial band (Fredericson 2000). If you are a runner, having a complimentary strength training program is necessary for minimizing injury risk.
6. Impaired Flexibility: Runners frequently have altered flexibility due to overuse of specific muscles. Improving these flexibility deficits is necessary for preventing and resolving injuries related to the Iliotibial band (Fredericson 2005).
7. Increased Knee Internal Rotation and Trunk Flexion: Running biomechanics also play a large role in Iliotibial band stress. Runners with Iliotibial band have greater hip internal rotation and trunk flexion during the stance phase (Sanchez 2006). The differences for knee internal rotation and trunk flexion are only 1 – 3 degrees, but these small differences are significant due to Gerdy’s tubercle (Sanchez 2006).
8. Increased Hip Adduction: Another running biomechanical flaw is increased hip adduction. When the foot lands under the body, hip adduction increases, causing more stress on the Iliotibial band.
Summary of 8 Causes of Iliotibial Band Syndrome
Iliotibial band syndrome is caused by a combination of anatomy, biomechanics, strength, flexibility, and motor control alterations. Other factors may cause individual people Iliotibial band syndrome. Running knee pain may also occur from many other causes. If you have running knee pain, see a Physical Therapist who understands running and sports. This approach can improve any symptoms and prevent them from reoccurring.
- Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006 May; 16(3):261-8.
- Orchard JW, Fricker PA, Abud AT, Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May-Jun; 24(3):375-9.
- Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005; 35(5):451-9.
- Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000 Jul; 10(3):169-75.
- Sanchez AR 2nd, Sugalski MT, LaPrade RF. Anatomy and biomechanics of the lateral side of the knee. Sports Med Arthrosc. 2006 Mar; 14(1):2-11.
- Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord. 2015 Nov 16;16(1):356. doi: 10.1186/s12891-015-0808-7.
Written by Dr. John Mullen, DPT.