OVERVIEW
It is called iliotibial band syndrome (ITBS) in the international literature, but is also widely known as the “runner’s knee”, as it is a common overuse injury which occurs, mainly, in long distance runners, but also in athletes who use their knees too much and make repetitive flexions and extensions, such as cyclists.
The role of the iliotibial band, which is an oblong thickening of the fascia and surrounds the outer surface of the thigh and the pelvis, is to offer static equilibrium to the knee surface during extension when someone is standing. It then moves forward in front of the lateral femoral epicondyle, and when the knee is flexed, it moves dorsally. It originates high up into the pelvis, above the hip and is inserted in the outer side of the tibia, near the head of the fibula. There, a serosa facilitates its movement over the bone protrusion of the femoral condyle, protecting it from friction.

HIGH RISK GROUPS
Repetitive movements and strain lead to irritation and small ruptures within the iliotibial band, but also in the serosa and the lateral femoral condyle. At the same time, training errors and its overwhelming style, inappropriate footwear, the sudden changes in the field and the stride angle, speed and distance. Predisposing factors include, leg length discrepancy, varus knees, superpronation, hip abduction vulnerability, and, in general, foot and hip conditions, among others.

WHICH ARE THE SYMPTOMS?
A study published in the Arthroscopy journal in 2003, reports that iliotibial syndrome accounts for 12% of all running-related injuries. The main symptom is pain in the knee’s outer surface, near the outer line of hip joint, which is likely to irradiate up to the hip. Initially, it is diffused and appears after the end of the training or the game, while the patients often complain that it worsens when they run downhill or after having stayed in a sitting position for too long. Over time, the pain is localized and acute around the femoral epicondyle and persists, even during rest.

WHICH IS THE BEST TREATMENT?
Diagnosis is performed through the obtaining of a detailed history and a clinical examination. Treatment is generally conservative, with the main priority being to tame the inflammation and relieve the pain. Initially, it is recommended to limit activities, such as running, that irritate the area, while swimming is recommended to maintain the athlete’s physical condition. If the symptoms are too intense, crutches are provided, while, in the acute phase, medication and ice therapy are recommended. Physiotherapy and strengthening exercises begin when the pain subsides.
For unresponsive patients, local cortisone injections and autologous cells containing growth factors are effective. However, especially in chronic cases, and after a monthslong conservative treatment without an effective result, surgery is also an option, for the release of 2 cm of the posterior part of the iliotibial band, at the point where it passes over the lateral femoral epicondyle.