Cycling and Knee Pain - What to do?

Iliotibial band friction syndrome (ITBFS):


What is the ITB?


The iliotibial band is the distal fascial continuation of the tensor fascia lata and gluteus maximus and inserts into the lateral aspect of the tibia-- Gerdy’s tubercle [1] This band is responsible for transmitting the force of the glute max and tensor fascia lata to extend the hip. At the knee, the ITB works as a knee flexor between full knee flexion to 30 degrees and as a knee extensor between 30 degrees and full extension.


What is ITBFS?


ITBFS is an overuse injury presenting as pain on the lateral aspect of the knee exacerbated with repetitive sporting activities ie: cycling or running [1]. Traditionally, ITBFS was considering to be the result of friction between the ITB and the underlying lateral epicondyle [1]. This friction was thought to contribute to local inflammation and irritation of the anatomical bursa lying between the tendon and the lateral epicondyle [1]. More recent studies suggest that a richly innervated and vascularized layer of fat and connective tissue separates the ITB from the lateral femoral epicondyle, and this is the source of pain seen in ITBFS [1].


Patient History


Individuals with ITBFS commonly present with an ache over the lateral aspect of the knee which is aggravated by running or cycling [1]. Generally, the pain often develops at the same distance/time during activity [1]. Longer training sessions, downhill running, or uneven surfaces is often an aggravating factor [1].


How can physiotherapy help?


  1. Exercise therapy

Physiotherapists can provide a range of appropriate exercises specific to an individual's condition. Upon assessment, a physiotherapist may find weaknesses in the foot and hip and thereby, provide specific exercises. Literature shows addressing foot and hip weaknesses is more favorable for long- term results [1,4].


  1. Manual therapy

Physiotherapist may also provide manual therapy in addition to strengthening based management. Considering tightness in the gluteal muscles and tensor fascia lata are commonly associated with ITBFS [1], manual therapy may be used. Manual therapy includes deep tissue massage, dry needling, or self massage with a foam roller or trigger point ball to help reduce muscle tension and tone in the ITB [1].


  1. Equipment assessment.

Physiotherapist may also provide assessment to the equipment used with the aggravating activity: shoes and/or cycling shoes. A common risk factor for ITBFS is collapsing of the arch in the foot [1,4,5] and may be addressed with evaluation and advice regarding shoes (running or cycling shoes) by a physiotherapist.


Take home:


Although ITBFS is a multifacets condition, a six-week rehabilitation programme involving education, NSAID prescription, ITB stretching, and hip strengthening appear to effectively reduce pain and prevent recurrence for up to six months [4]. Biomechanical factors associated with ITBFS including taping, foot orthoses and gait retraining require further research for long term benefit >12 months [4] however, these factors can be clinically assessed and addressed by a physiotherapist to maximize individual’s outcomes.


If you have any questions regarding knee pain or think you may benefit from physiotherapy, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. 


References:

  1. Brukner P. Brukner and Kahn’s Clinical Sports Medicine. 4th Edition. McGraw-Hill Australia; 2012.


  1. Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010;20(4):580-7. doi: 10.1111/j.1600-0838.2009.00968.x


  1. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007;10(2):74-6. doi:10.1016/j.jsams.2006.05.017


  1. Balachandar V, Hampton M, Riaz O,Woods S. Iliotibial band friction syndrome: a systematic review and meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscles, Ligaments and Tendons Journal 2019;9:181-193. doi:10.32098/mltj.02.2019.05


  1. Van de Worp MP, van der Horst N, de Wijer A, Backx, FJ, & Nijhus-van der Sanden MW. Iliotibial band syndrome in runners: a systematic review. Sports Med. 2012;42(11):969-992. doi:10.2165/11635400-000000000-00000.





Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010 Aug;20(4):580-7.

  1. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-6; discussion 77-8.

 

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