Iliotibial band friction syndrome (Runners' knee)

Iliotibial band friction ultrasound guided injection

Causes of IT band friction syndrome

What are the causes of IT band friction syndrome?

The IT band is a tendinous structure that runs from the outer aspect of the hip, passes at the outer aspect of the knee and then attaches to the outer part of the shin bone (Tibia).

It is caused by friction between the IT band and the underlying bone (the femoral condyle). The increased pressure (friction) in this area increases during activities that involve bending the knee (knee flexion) and is highest at 30 degrees of knee flexion. This condition is very common in athletes who run and cycle. Marathon runners, in particular, may experience this, particularly if they are increasing their exercise intensity in the period leading to the competition. Some studies found that muscle imbalance, particularly gluteal muscle group weakness and quadriceps muscle group stiffness, can predispose to IT band friction.

What are the symptoms of IT band friction syndrome?

· Sharp pain in the outer aspect of the knee when doing activities (like running)

· Pain can be felt worse by pressing at the outer aspect of the knee.

· The pain is usually triggered by activities (like running) and improves with rest. Runners usually start feeling a sharp pain 5-10 minutes after exercising.

What other conditions can be mistaken for IT band friction?

Other causes of pain at the knee's front or outer aspect can be mistaken for IT band friction syndrome. These include:

For more information, please see our articles about pain at the front and pain at the outer aspect of the knee.

How is IT band friction syndrome diagnosed?

Usually, the condition is suspected clinically and confirmed by imaging. MRI is the best test to assess for possible IT band friction syndrome. It will show local inflammation and possibly small fluid volume at the friction site. For any changes, it will also be useful for assessment of the adjacent structures (like the patellofemoral (knee cap) joint, the menisci and the patellar tendon. Ultrasound is also useful in the assessment as it may show small fluid volume and local inflammation. Furthermore, ultrasound is very useful for performing ultrasound-guided injection treatment. An ultrasound-guided steroid injection for this condition can be therapeutic (help with the pain) and diagnostic (confirm the diagnosis if you notice a good response from the injection).

How is IT band friction treated?

The first line of therapy usually consists of using anti-inflammatory tablets (like Ibuprofen) and a physiotherapy program aiming to correct the biomechanics of the lower limb. In particular, strengthening the gluteal muscle group is very useful for the treatment. The treatment may also include activity modification and a gradual return to activity. An ultrasound-guided steroid injection is also usually useful for the treatment.

Do I need a steroid injection for IT band friction?

If the response from the above treatment is inadequate or slow, especially if you are training for a competition, then an ultrasound-guided steroid injection can be helpful for the management.

What is a steroid/cortisone injection?

Corticosteroid (cortisone) is a well-established anti-inflammatory medicine that manages various inflammatory conditions. Steroid injections reduce the inflammation in the targeted area, thus providing a solid and local anti-inflammatory effect to help control the symptoms and allow the patient to manage the condition, usually by undergoing a physiotherapy rehabilitation program. The injections usually also contain a local anaesthetic that provides immediate pain relief lasting a few hours. The injection can be therapeutic (help with the pain) and diagnostic (confirm the diagnosis if you notice a good response from the injection).

What is the benefit of having an ultrasound-guided injection for IT band friction syndrome?

There is significant evidence that when injections are done under ultrasound guidance, they result in superior outcomes, with better pain relief, longer effects and more improvement in function compared to injections done without ultrasound. This is because ultrasound guidance allows for accurate placement of the needle and, thus, delivery of the medicine to the exact site of pain. Performing the injection under ultrasound guidance allows for visualisation of the adjacent structures so they can be assessed also prior to performing any injection, and reduces the risk of tissue injury at the injection site.

What are the possible side effects of steroid injection for IT band friction syndrome?

Most people have a steroid injection without any significant side effects. Possible side effects include Pain and discomfort at the site for a few days (steroid flare), focal skin colour changes and minimal risk of infection. There is a possibility that the injection may not work for you. To find out more about corticosteroid injections, please see your FAQs.

Do I need to rest after steroid injection for IT band friction syndrome?

Yes, you are advised to rest and avoid strenuous activity for 48 hours after the injection.

Summary

IT band friction syndrome is common in runners and can be limited to their activities. Physiotherapy and activity modification are beneficial in management. Combining this with an ultrasound-guided steroid injection is often very useful for the treatment, as it will help to reduce the inflammation at the site of friction and allow for more effective physiotherapy.