Chiropractic and Iliotibial Band (ITB) syndrome

The Iliotibial band is a dense fibrous tendonous band that extends from the pelvis to the lower leg (tibia).  If the ITB becomes tight or thickened, it may rub along the lower portion of the thigh bone (femur) at the knee and cause aching, irritation, inflammation, and pain.  This is a very common injury to runners

Classic Presentation of Iliotibial Band Syndrome

• Pain/aching on outside of knee with activity
• Increased pain with running or walking downhill
• Improves with rest
• Muscle soreness, tenderness, or Trigger Points in the gluteal muscles
• May be associated with Trochanteric Bursitis of the hip

What Causes Iliotibial Band Syndromee

ITB syndrome is usually caused by a weakness in the main hip abductors, Gluteus Medius.  This weakness causes an overactive Tensor Fascia Latae muscle, which can then pull on the ITB, causing it to increasingly rub against the bone on the outside of the knee, resulting in inflammation and pain.
There are numerous predisposing factors to ITB syndrome, which include:

• Over-pronation of the feet
• Weak and /or tight Gluteus Maximus, Gluteus Medius, Quadriceps, or Hamstring musculature
• Overtraining
• Poor shock absorption due to inappropriate or worn out shoes
• Overactive and/or tight hip adductors (muscles on inside of thigh)
• Spinal and pelvic joint dysfunctions
• Anatomical leg length asymmetry or bow-legged knees

Chiropractic Treatment of Iliotibial Band syndrome

The first step is to evaluate the pelvic joints and lumbar spine for proper biomechanical function, as dysfunction of these joints may contribute to neurological inhibition of the gluteal muscles, causing weakness.  This is often overlooked any may lead to ineffective treatment or reoccurring problems.  Also, it is very important to evaluate the feet for proper biomechanical function and to determine if orthotics are needed.
After the neuro-mechanical evaluation and correction of the spine, pelvis, and feet, soft tissue treatment (Active Release Technique) must be applied to the Iliotibial band and other associated tight muscles, as well as strengthening the associated weak musculature.
A long term rehabilitative program/strategy, even when symptoms have lessened, will help to limit this becoming a reoccurring problem.