Iliotibial band syndrome, also referred to simply as ITB, is a common condition that causes knee and leg pain. In some studies it can affect up to 50% of people, particularly in populations that do a lot of exercise. This article will explain what the iliotibial band is, how its dysfunction causes the ITB syndrome and what you can do about it.

How is ITB syndrome diagnosed?

ITB syndrome is usually diagnosed by your doctor or rehabilitation provider (such as physiotherapist, osteopath or myotherapist) through a physical examination. This is usually sufficient, but if there are any questions about the diagnosis you may also have an X-ray, ultrasound or MRI of your knee.

How is ITB syndrome treated?

• Conservative treatment: The treatment for ITB syndrome is usually conservative, which means we normally avoid invasive procedures.
• Enough rest: Commonly, you should avoid the trigger that caused the condition. This might be avoiding certain shoes, exercises or positions. Sometimes enough rest from the trigger can be enough to cure the condition, however occasionally if you resume the same trigger the symptoms can return.
• Anti-inflammatories: Anti-inflammatories can be used to settle the pain. These can be taken as tablets or as a gel to the affected area.
• Cold compresses/warm packs: Cold compresses can be used in the early stages of the condition, however when it has persisted for a long time warm packs can help to loosen up prior to exercise.
• Physical therapy: The mainstay of treatment is physical therapy. This includes stretches and strengthening. A ball or foam roller can be used on the outer part of your leg to help with this. A physical therapist can teach you techniques to warm up and cool down after exercise, to aid healing and prevent flare ups.
• Steroid injection: For severe, chronic cases, your doctor may recommend a steroid injection. This is usually administered via ultrasound and can work as an anti-inflammatory in the trigger areas.
• Surgery: Very rarely, surgery can be performed where a small part of the ITB is removed on the outer side of your knee. This can be done through a small cut on the side of your knee or with a camera. After an operation, physical therapy is still important for full recovery.

A final note

ITB syndrome is commonly treated by doctors and physical therapists. Most of the time it resolves on its own with small adjustments to your exercise regimen or lifestyle.

Resources and support

IT Band Stretches, Strength Exercises, and More – Healthline

Iliotibial Band Friction Syndrome – Medscape

Iliotibial Band Syndrome – Cedars-Sinai

Iliotibial Band Syndrome – Cleveland Clinic

Method of Injury

The ACL is commonly injured in active people during sports such as basketball, tennis, skiing, football and soccer. It can be injured when there is a mix of jumping, pivoting, changing fast direction or speed. It can also be injured from direct trauma, such as in a car accident or a tackle.

Prognosis for ACL injuries

Whether you have surgery or not, physical therapy is necessary to strengthen the ligaments and muscles that support the knee. It is common to develop early arthritis in the knee that sustained the ACL tear, which makes exercise and strengthening even more important.

Further resources & patient information about ACL injuries

https://patient.info/bones-joints-muscles/sports-injuries/knee-ligament-injuries https://patient.info/doctor/knee-ligament-injuries-pro 

https://emedicine.medscape.com/article/89442-overview 

https://www.healthline.com/health/anterior-cruciate-ligament-acl-injury

People who run or who play sports that involve lots of running commonly present to physiotherapists and doctors with shin pain. There are several possible causes for pain in this part of the leg. Here are 3 underlying conditions that should be considered.

Shin Splints- what is it?

• Shin Splints is also known as Medial Tibial Stress Syndrome or MTSS for short.
• It leads to pain along the shinbone, between your ankle and your knee.
• It’s often caused by over-training or by increasing the amount of running you do over a short time frame.
• Building your level of fitness and activity up more gradually may help you to avoid Shin Splints.
• The precise cause of the pain is not known, but it is believed to be a stress reaction due to the muscle and tendons pulling on the bone.

What is Restless Legs Syndrome?

• Restless legs Syndrome is a common neurological (nerve) disorder which leads to a strong urge to move the legs, as well as other unpleasant sensations in the legs.
• It can have a major impact on a person’s life- in particular, it can affect the quality of sleep.
• Restless Legs Syndrome appears to be related to Dopamine levels. Dopamine is a chemical messenger which naturally occurs in the brain- and medications which increase Dopamine levels often relieve the symptoms- at least in the short term.

What are the symptoms of Restless Legs Syndrome?

• The classic symptom is an overwhelming urge to move the legs during rest or inactivity, especially in bed at night.
• People may experience a crawling sensation, pins & needles, aches, pulling or itching in the legs.
• The symptoms are usually worse in the evening and through the night, though they may improve in the early hours of the morning, allowing a few hours of good sleep.
• Bouts of leg movement can also occur, at night or during the day- these are involuntary, twitchy movements.
• The symptoms and severity can vary widely from person to person, and may come and go over time
• Disturbed sleep causes fatigue, changes in mood, poor concentration and can have a negative impact on day-to-day functioning.
• In the earlier stages, the symptoms may come and go, with breaks of weeks or months. However, over time the symptoms tend to become more consistent and troublesome, particularly if related to an underlying condition.

What is the treatment for Restless Legs Syndrome?

Treatment for restless legs syndrome may include lifestyle changes as well as medications:

Non medication treatments:

• In mild cases, lifestyle changes may help- good sleep hygiene, reduction of caffeine and alcohol intake, quit smoking, increase exercise, stretching, massage and relaxation techniques.
• If you’re taking any regular medications, you should check the label to see if Restless Legs Syndrome could be a side effect.
• If iron levels are low, supplements should be taken- it’s advised to aim for a ferritin (iron store) level above 50 ng/Ml

Medications

• Medication may be considered if symptoms are having a significant negative impact on day to day activities, quality of life and sleep.
• Recent research shows that many of the medications previously used to treat Restless Legs Syndrome have the potential to cause worsening of symptoms over time- including antihistamines, anti-nausea drugs, dopamine agonists, antidepressants, beta blockers, antiepileptics and lithium.
• Dopamine agonists and Gabapentinoids can help the sensory symptoms such as pins & needles. The Dopamine Agonists can be more helpful for the periodic leg movements, while Gabapentinoids may improve sleep.
• However, long-term studies show that if taken for 5 to 10 years, Dopamine Agonists may stop working, and symptoms may actually get worse.
• Where medication is deemed appropriate, it is recommended to start with a Gabapentinoid, while Dopamine Agonists should be avoided unless absolutely necessary, and then if needed to use the lowest effective dose for the shortest possible time.

What is the prognosis?

• Unfortunately, Restless Legs Syndrome is often a lifelong condition- though it may come and go over time
• Lifestyle changes and medications often help
• Symptoms may worsen over time- more so in people with an underlying cause.

If you require more information about Restless Legs, or wish to know more about treatment options for Restless Legs Syndrome, check out the Brain Foundation website , or speak to your GP.