ITB Syndrome: How Physiotherapy, Shockwave and MLS Laser Can Help
Written by: Dr Richard Domenic Simeoni | Nano Physiotherapy | Hornsby, NSW
Pain on the outside of the knee is a common problem in runners, particularly when training volume starts to increase.
One possible cause is iliotibial band syndrome, usually shortened to ITB syndrome or ITBS.
It often starts as a mild ache during a run, but over time the pain can become sharper and may start appearing earlier and earlier into your training. Hills, longer runs and faster sessions can be particularly aggravating.
Physiotherapy can help by identifying why the area is being overloaded, modifying training where necessary and gradually improving the strength and capacity of the lower limb.
At Nano Physiotherapy in Hornsby, we can also incorporate treatments such as Shockwave Therapy and MLS Laser Therapy alongside more traditional physiotherapy and exercise rehabilitation where appropriate.
What Is ITB Syndrome?
The iliotibial band is a strong band of connective tissue running down the outside of the thigh from the hip towards the knee.
ITB syndrome generally causes pain around the outside of the knee where the ITB interacts with structures near the lateral femoral condyle.
Symptoms are commonly associated with repetitive activities such as running and cycling.
You might notice:
Pain on the outside of the knee during running
Symptoms that begin after a predictable distance
Pain running downhill
Discomfort after increasing running volume
Tenderness around the outside of the knee
Pain that improves with rest but returns when training resumes
Unlike a sudden ligament or muscle injury, ITB syndrome will often develop gradually.
Why Does ITB Syndrome Develop?
There usually isn't one single cause.
A common trigger is simply doing more than the body is currently prepared for.
This might include suddenly increasing your weekly kilometres, adding hills, returning to running after a break or increasing the number of faster training sessions.
Strength and control around the hip, pelvis and lower limb may also contribute.
This is why simply stretching or foam rolling the ITB doesn't always solve the problem.
We need to look at why the outside of the knee is repeatedly becoming irritated in the first place.
Do You Need to Stop Running?
Not always.
Depending on how irritable the knee is, you may be able to continue running with some temporary changes.
For example, reducing your distance, avoiding hills or decreasing running frequency for a short period may allow symptoms to settle while rehabilitation begins.
For more painful cases, a temporary break from running may be appropriate.
The aim is generally to find a level of activity that the knee can tolerate and then gradually build from there.
Strengthening and Exercise Rehabilitation
Exercise rehabilitation is an important part of treating ITB syndrome.
Depending on your assessment, this may include strengthening the glutes, hips, quadriceps and other muscles throughout the lower limb.
We may also look at single-leg control, running-specific movements and eventually higher-load activities such as hopping.
As symptoms settle, running volume can then be progressively increased.
The goal isn't just to make the pain disappear.
We want to improve your ability to tolerate the running load that caused the symptoms in the first place.
Can Shockwave Therapy Help ITB Syndrome?
For more persistent lateral knee pain, Shockwave Therapy may sometimes be incorporated into treatment.
Shockwave delivers acoustic pulses into the affected area and is commonly used in physiotherapy for persistent musculoskeletal and tendon-related conditions.
With ITB syndrome, it may be considered when local pain and sensitivity around the outside of the knee have become persistent.
It isn't a replacement for changing training load or improving strength.
Instead, we may use shockwave as an additional treatment to help reduce symptoms while progressing exercise rehabilitation.
What About MLS Laser Therapy?
MLS Laser Therapy is another treatment option available at Nano Physiotherapy.
MLS Laser uses specific wavelengths of light delivered into the affected area, a process sometimes referred to as photobiomodulation.
The aim is to influence processes associated with pain, inflammation and tissue recovery.
For someone with an irritable lateral knee, MLS Laser may be used as a non-invasive way of helping manage pain and local sensitivity.
As with shockwave, however, we don't generally rely on laser alone.
The longer-term solution still involves addressing training load, improving strength and gradually returning the knee to normal activity.
Why Choose Nano Physiotherapy for ITB Syndrome?
ITB syndrome is a good example of why having several treatment options can be useful.
At Nano Physiotherapy in Hornsby, treatment isn't limited to one technique.
We combine experienced physiotherapy assessment, hands-on treatment and progressive exercise rehabilitation with additional technologies such as Shockwave Therapy and MLS Laser Therapy where they are appropriate.
This allows treatment to be adjusted depending on how irritable the problem is and how you are progressing.
For one person, exercise and modifying their running load may be all that's required. For someone with more stubborn symptoms, shockwave or MLS Laser may be incorporated alongside that rehabilitation.
The important part is that these modalities support the rehabilitation process rather than replace it.
If pain on the outside of your knee is repeatedly stopping you from running, a physiotherapy assessment can help identify what's contributing to the problem and provide a structured plan for getting you back to your normal training.
