Iliotibial Band Friction Syndrome

ITB is a common running injury that occurs on the lateral side of the knee. It occurs in long distance runners where repetition and over-use are the key factors. The pain is aggravated by running downhill and it gets worse as the run progresses to the point that the runner must stop.

This is a controversial condition as there are differing opinions as to the cause. Some opinions believe the cause to be more common in supinators, and others in pronators.
There are different schools of thought on the issue, depending on who you see.

The cause may be a tight Iliotibial Band Muscle, that leads to tension of the ITB tendon over the lateral Femoral Condyle, leading to friction on running.

It can be caused by excessive lateral heel striking (supination), and excessive pronation both of which will result in Excessive Internal Rotation of the Tibia.

Internal rotation of the Tibia is a natural consequence of pronation or a delayed forefoot loading due to excessive lateral or supinated heel strike.
As the Tibia rotates internally, and fails to de-rotate at the correct time, the knee crosses the midline of the body, leading to a tension of the ITB over the Femoral Condyle. Should this fault be repeated enough as in long distance running, then inflammation can set in.

The cause can be as a consequence of a variety of foot types, tight muscles, weak muscles and incorrect footwear.

There is no specific foot type that leads to the condition, every case has to be dealt with on its merits.

Treatment involves identifying the appropriate biomechanical factors, correct stretching and footwear.
Orthotics or insole adjustments may be necessary to assist the foot in functioning better. This will reduce internal rotation of the leg, keeping the knee on an even keel during running.
Physiotherapy can assist recovery and advise on stretching.
Biokinetisists can assist with muscle imbalances.
Cortisone injections are often used to relieve pain, but if the mechanical factors are not dealt with, it may not last very long.
Surgery to lengthen the tendon, or cut a window in the femoral condyle are options if all else fails