Pain on the outside of the knee (lateral knee pain) can be due to the iliotibial band (ITB). This has historically been called a ‘friction’ causing injury, where the ITB band is so tight that it rubs against the lateral knee. People have then used foam rollers to try and ‘loosen’ off the ITB. This is something very painful to do and does nothing for the ITB and if anything makes it worse in the presence of injury. The ITB is a connective tissue known as fascia, which can be thought of as the glad wrap of the body.

The ITB is actually supposed to be a very tight band of tissue, if it is loose then we have an anatomical problem! What role does the ITB play then? Well its primary role is that it serves as an energy storage and release system. During running, it stores 5-14% of the total work. If the ITB was loose, then it would leak energy and not be able to store and release it effectively. It also acts as a stabiliser of the knee, where it supports the kneecap from dislocating medially.

ITB compression syndrome is the most common cause of lateral knee pain! It is not caused by ‘friction’ as this is anatomically impossible, with the ITB being tightly tethered to the length of the femur (thigh bone). What actually occurs is a rippling effect of the ITB’s anterior and posterior portions. Where tension in the anterior band, results in tension of the posterior band as the knee flexes. This resulting rippling tension of the ITB, compresses the highly innervated fat tissue under the ITB.

What causes ITB compression syndrome?

Well firstly, males are more likely to get ITB pain then females. Anatomy certainly can play its role alongside biomechanics. However, the primary cause of this issue is due to rapidly increasing training (running) loads. Those who are trail runners are more prevalent for this injury, whilst downhill running, speedwork and overall running distance also play a part.

Another common misconception is that the having weaker hip muscles is a risk factor. However, hip weakness is not a known risk factor from the research. What typically occurs as a result of ITB pain is having hip muscle strength deficits.

This injury has many misconceptions, and it is very painful. Director and osteopath Jackson has ensured he is up to date on the modern research and will bust the myths of this injury. At The Reform Lab Osteopathy we provide our evidence based management in the elite gym Project Reform. This ensures that your management is not limited by equipment.