The iliotibial band (ITB) is a thick band of tissue that extends down the lateral side of the leg from the thigh down over the knee and attaches to the tibia. When the knee flexes and extends, the ITB slides over the bony parts of the outside of the knee.

Mechanism of Injury

Friction occurs when the knee bends during running in soccer and the tendon moves back and forth across the distal femur (along the outside). This results in localized symptoms of tendinitis. This friction can be magnified by:

• increased training (especially running hills or too much too soon)
• poor shock absorption from shoes or rigid feet
• bio-mechanical malalignment

Soccer activities that involve prolonged running can cause the ITB over the insertion (lateral femoral condyle) to become irritated and inflamed. Factors contributing to this condition are:

• genu varum (bow legs)
• pronation of the foot (foot collapses inward)
• leg length discrepancy
• running on a banked surface

Signs and Symptoms

• Pain will be elicited along the outside of the knee, particularly, when the athlete stands with his or her full weight on the injured leg and bends the knee 30 – 40 degrees (knee flexion).
• Pain with downhill and level ground running or jumping, most intense when the foot hits the ground.
• The athlete may walk with a stiff leg to relieve the pain.
• Usually no history of a direct blow or twisting injury.
• A positive Ober test. Athlete lying on unaffected side with leg in hip extension and full abduction – then allowing the leg to drop into adduction, will illicit pain in the inflammed areas.

On-Site Management

P.R.I.C.E. PROTECT the area by stretching before and after any activity. REST the area by decreasing soccer training to promote healing. ICE the area to reduce inflammation. Apply COMPRESSION to the area to move inflammation away. ELEVATING the leg is difficult and often does not help with recovery. 

Medical Referral. A physician may prescribe anti-inflammatory medication or orthotics, and a sports medicine practitioner will outline proper stretching techniques.

Rehabilitation. If pain persists, seek the advice and treatment of a physiotherapist.

Stretching. Stretching to reduce the tightness of the band is also key to recovery and prevention. While standing, cross the injured leg behind the good one, then lean away from the injured side, reaching your opposite hand down towards the involved leg.

Shoes. Shoes with good shock absorbency and motion control should be worn.

Return to Activity. When pain-free, return to activity gradually. Avoid downhill and banked running surfaces. After comfortable running on flat surfaces, gradual introduction to hills can occur, beginning with a low grade and shorter distances.

Prevention

• A proper warm up and cool down should be implemented.
• Emphasize proper stretching before and after activity.
• Prepare properly for increased activity volume (especially running).

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