The ITB
The iliotibial band is a tendon-like structure that runs all the way down the outside of the thigh from the hip bone to the knee where it attaches to the tibia, femur, fibula & patella. It provides attachment to the gluteus maximus & TFL muscles at the hip, & could be referred to as the “deltoid muscle of the hip”.
Iliotibial band pain syndrome (ITBPS) can leave the runner crippled in pain, and often appears like clockwork at a given point during a run, with the runner unable to run “through” the pain. This injury is not unique to runners: it can be seen in field athletes, basketball players, rowers & has been reported to occur in up to 24% of road cyclists. (Holmes 1993)
Friction or compression?
Initially termed “ITB friction syndrome”, we now know from numerous studies that it’s not friction but more compression of the ITB that contributes to the pain. (Geisler 2020) The ITB is placed under the greatest compression when the knee is bent between 20-30degrees during the stance phase of gait.
From the work of Hamill, we learn that strain RATE is more important than the amount of strain in the formation of ITBPS. If there is a decreased ability of the body to absorb shock during the 20-30degrees of knee flexion during the stance phase of running, then the ITB experiences a rapid increase in strain, & compression of the ITB can result. A potential reason why ITBPS appears at a certain point in a run may be due to fatigue of the muscles of the hip & leg, which then increase ITB compression.
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References
Geisler, P. and T. Lazenby (2016). "Iliotibial Band Impingement Syndrome: An Evidence-Informed Clinical Paradigm Change." International Journal of Athletic Therapy and Training 22: 1-30.
Geisler, P. R. (2020). "Iliotibial Band Pathology: Synthesizing the Available Evidence for Clinical Progress." J Athl Train.
Hamill, J., et al. (2008). "A prospective study of iliotibial band strain in runners." Clin Biomech (Bristol, Avon) 23(8): 1018-1025.
Holmes, J. C., et al. (1993). "Iliotibial band syndrome in cyclists." Am J Sports Med 21(3): 419-424.