4 effective exercises for iliotibial ligament syndrome

We start with the symptoms of iliotibial band syndrome to find the most appropriate therapy and the most effective and simple exercises.

The iliotibial ligament is a fibrous ligament (consisting of connective tissue) that runs along the outside along the entire thigh.

There are various theories regarding the development of these ailments. Some authors believe that it is a result of the friction between the ligament and the knee.

If the knee is bent, the ligament shifts behind the epicondyle (a bone protrusion on the femur), while the ligament moves in front of the epicondyle when the knee is extended.

According to other authors, the syndrome is caused by the pressure of the ligament against a layer of fat with many blood vessels and nerves.

The presence of many blood vessels may explain the local swelling often seen in patients diagnosed with iliotibial band syndrome.

This tissue is located between the fascia and epicondyle.


Causes of iliotibial ligament syndrome

Examined corpses showed that the width of the iliotibial tract was greater in people suffering from traction syndrome of the iliotibial ligament.

This variant can affect individual susceptibility to this syndrome.

Risk factors of iliotibial ligament syndrome

Factors that increase the possibility of tendinitis include:

  1. A muscular imbalance such as the weakness of the middle gluteal muscle or the (posterior) knee flexors in relation to the quadriceps.
  2. The sport practised,
  3. Too many kilometers running (Fredericson – 2005),
  4. Abnormalities in leg alignment, for example, overextension or internal rotation of the knee.
  5. Knickfuß, even if not all authors agree.

In my practice, I often see cyclists and runners with this problem (Fairclough – 2006).

Running downhill favors the syndrome of iliotibial ligament friction because the angle of knee flexion is reduced during foot rest.

This causes:

  1. Greater friction,
  2. Increase in the pressure of the fibrous ligament against the soft tissue parts of the knee.

While this may seem harmful to many, sprints and fast runs on flat terrain are likely less responsible for causing or exacerbating iliotibial ligament friction syndrome.

This happens when the foot is on the floor, the bending angle of the knee is greater and there is no friction (Orchard – 1996).

Studies have shown that weakness or disability of the middle and small gluteal muscles are risk factors for the syndrome.

If these muscles are not activated during the phase of putting the foot on, the stabilization of the pelvis is reduced.

In addition, the control of abduction (movement away from the body) of the thigh is not well controlled.

Therefore, other muscles must compensate for this weakness. The consequences are excessive tension of other tissues of the thigh and shortening of connective tissue ligaments.

Fredericson et al. studied a group of 24 runners with iliotibial ligament syndrome and found that on the affected side, the strength of the abductors (external muscles) of the hip was lower.

It would be logical to associate the weakness of the external hip muscles with this disorder, since weak abductors when walking can cause greater hip adduction (inward movement of the knee).

The consequences are:

  1. increase in tension of the iliotibial ligament,
  2. Greater pressure on the underlying tissue.

The studies of MacMahon and Noehren have also confirmed this version (Lavine – 2010).

Symptoms of iliotibial ligament syndrome

Symptoms include:

  1. pain on the outside of the knee, especially during activities,
  2. restriction of movement,
  3. Knee swelling.

Diagnosis of iliotibial ligament syndrome

The doctor performs a physical examination to determine the location of the pain.

The doctor may order an X-ray examination and magnetic resonance imaging.

Magnetic resonance imaging shows a thicker iliotibial ligament on the affected knee than on the other knee.

In addition, fluid often accumulates between the fibrous fascia and the knee (Ekman – 1994).

The special physical test for this disorder is the upper test.

  1. The patient lies on the healthy side on an examination table,
  2. The examiner stands behind the patient and stabilizes the pelvis with one hand,
  3. With the other hand he bends the knee and shifts the thigh backwards,
  4. Then he lets it sink down,
  5. The end position is with the thigh in extension (backwards) at maximum adduction (inwards).

The test is positive if the leg does not sink down.

However, in a study by Devan et al., a positive upper test in college athletes does not correspond to this syndrome.

Treatment of iliotibial ligament syndrome

Conventional treatment consists of:

  1. Avoiding the movement that causes the inflammation of the tendon to stimulate the body’s self-healing.
  2. ice packs,
  3. Insoles for foot position problems are very effective in patients with knuckle foot (Dodelin et al. – 2018),
  4. Muscular strengthening of the hip,
  5. Manual therapy to reduce the tone (contraction) of some muscles, for example, the psoas, gastrocnemius and piriformis, and additionally to release the blockage of the knee joint (Shamus – 2015),
  6. Anti-inflammatory drugs (such as ibuprofen), even if the effect is only temporary,
  7. Some instrumental therapies may be useful for treating tendinitis of the iliotibial tract, especially laser therapy. In the case of tendinitis with calcifications, shock waves can help.

4 simple and effective exercises for iliotibial band syndrome

According to Fairclough (2007), iliotibial ligament syndrome is associated with weakness of the hip muscles.

Let’s look at a few strengthening and dynamic stretching exercises.

Yes, I would avoid static stretching because its success is not supported by any scientific basis.

Stretching of the iliotibial ligament when sitting

  1. Sit on a fitness mat,
  2. Cross your legs, the healthy knee must remain down,
  3. Turn the shoulders and support the elbow to the side of the affected knee,
  4. Press backwards with your elbow to lengthen the iliotibial ligament.

Stretching of the iliotibial ligament when lying down

  1. Lay on a fitness mat,
  2. Place the ankle of the affected leg over the other knee,
  3. Interlace the fingers behind the other thigh,
  4. Pull the thigh to the chest.

Strengthening the gluteal muscles

  • Starting position: with spread legs and an elastic band below the knees,
  • Do a squat without the rubber band falling off,
  • return to the starting position,

Strengthening the middle and large gluteal muscle

This exercise can be done with a fitness ball or just on the mat.

  1. Lie on your back,
  2. bend knees,
  3. support feet on the ball or mat,
  4. raise the pelvis,
  5. When the body is stable, raise the “healthy” leg with the knee stretched.
  6. Return to the starting position.

Surgery for iliotibial ligament syndrome

In cases that do not respond to therapy, surgery may be required.

When to operate?

Martens et al. recommend waiting 9 months without surgery before considering surgery.

The typical surgical treatment is open surgery.

It consists in the removal of a small part of the posterior iliotibial ligament, which is located above the lateral femoris epicondyle.