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Iliotibial Band Syndrome
Medical Author:
Benjamin Wedro, MD, FACEP, FAAEM
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
Iliotibial band syndrome facts
Iliotibial band syndrome is an overuse injury of tissues of the outer thigh and knee.
The iliotibial band runs along the lateral or outside aspect of the thigh and is an
important structure that stabilizes the knee as it flexes and extends.
Inflammation of the IT band can occur as it crosses the femoral epicondyle on the lateral
side of the knee joint.
Iliotibial band syndrome is an overuse injury causing pain on the outside part of the knee
especially during running when the heel strikes the ground.
RICE and anti-inflammatory medications are first-line treatments.
Physical therapy may be helpful and, rarely, surgery is an option.
Prevention is a key component and includes keeping muscles well stretched.
What is iliotibial band syndrome?
Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the tissues located
on the outer part of thigh and knee. It causes pain and tenderness in those areas, especially just
above the knee joint. Iliotibial band syndrome is more common in runners and bicyclists.
The iliotibial band is a thick band of tissue that begins at the iliac crest in the pelvis, runs down
the outer part of the thigh, and crosses the knee to attach into the top part of the tibia or
shinbone. The iliotibial (IT) band helps stabilize the knee through its range of motion.
When the knee is flexed, the IT band is located behind the femoral condyle, a bony outcropping
of the femur or thighbone at the knee. The IT band moves forward across the condyle when the
knee is extended. There is a sac or bursa that allows the band to glide across the condyle, but
should inflammation occur in the area, the increased friction from repeated rubbing of the
iliotibial band against the bony condyle can cause pain, especially along the outer (lateral)
aspect of the knee joint.
If the symptoms are ignored, the inflammation can continue and scarring can occur in the bursa,
decreasing knee range of motion and causing increasing pain with decreasing activity.
What causes iliotibial band syndrome?
Iliotibial band inflammation is an overuse syndrome that occurs often in long-distance runners,
bicyclists, and other athletes who repeatedly squat. The iliotibial band syndrome may be the
result of a combination of issues from poor training habits and poor flexibility to muscle and
other mechanical imbalances in the body.
Anatomy issues may include differences in the lengths of the legs (a leg-length discrepancy), an
abnormal tilt to the pelvis, or bowed legs (genu varum). These situations can cause the iliotibial
band to become excessively tight, leading to excess friction when the band crosses back and
forth across the femoral epicondyle during activity.
Runners can develop iliotibial band syndrome symptoms should they make mistakes in their
training. Roads are canted or banked with the center of the road higher than the outside edge to
allow for water runoff. If a runner always runs on the same side of the road, it produces the
same effect on the body as having a leg-length discrepancy. One leg is always downhill
compared to the other, and the pelvis has to tilt to accommodate the activity. Running too many
hills can also cause inflammation of the IT band.
Bicyclists may develop IT band inflammation should they have improper posture on their bike
and "toe in" when they pedal. This can cause the same effect as bowed legs, increasing the
angle of the IT band as it crosses the knee, increasing the risk of inflammation.
Other activities with increased knee flexion can cause symptoms and include rowing and weight
lifting, especially with excessive squatting.
What are iliotibial band syndrome symptoms and signs?
Pain on the outer side of the knee is the most common symptom of iliotibial band syndrome and
is due to inflammation of the area where the band crosses back and forth at the femoral
epicondyle. Initially, there may be a sensation of stinging or needle-like pricks that are often
ignored. This can gradually progress to pain every time the heel strikes the ground and finally
can become disabling with pain when walking or when climbing up or down steps.
Some patients may feel a snapping or popping sound at the knee, and there may be some
swelling either where the band crosses the femoral epicondyle or below the knee where it
attaches to the tibia. Occasionally, the pain may radiate along the course of the IT band all the
way up to the outer side of the thigh to the hip.
How is iliotibial band syndrome diagnosed?
Often, the diagnosis of iliotibial band syndrome can be made by the patient's story of symptoms.
The patient describes the progression of lateral knee pain that is made worse when the heel
strikes the ground. Physical examination is helpful because the area of pain can often be
palpated with tenderness and swelling felt over the femoral epicondyle where the bursa or sac is
located.
The health care professional may also look for leg-length discrepancy and muscle imbalance in
the legs and back. There is tenderness of the outer thigh just above the knee joint while the
knee and hip joints are normal.
Usually, a full physical examination of the low back and legs, including the hips, knees and
ankles, is performed to detect other potential causes of outer knee pain.
Blood tests and X-rays are usually not required.
What is the treatment for iliotibial band syndrome?
Iliotibial band syndrome is an overuse injury that causes inflammation. Initial treatment includes
rest, ice, compression, and elevation (RICE).
Anti-inflammatory medications, like ibuprofen (Advil, Motrin) and naproxen (Anaprox, Aleve),
may be helpful. Please be aware that over-the-counter medications like these can have
potential side effects and interactions with prescription medications and it is worthwhile asking
your care provider or pharmacist whether they are safe to take.
Should treatments not work, physical therapy may be needed to decrease the inflammation at
the IT band. Some treatments focus on flexibility and stretching. Friction rubbing may occur over
the IT band at the femoral epicondyle to break down inflammation and scarring.
Therapeutic ultrasound techniques may be used, including phonopheresis (ultrasound propels
anti-inflammatory medications through the skin into the inflamed tissue) and iontophoresis
(electricity is used instead of ultrasound).
The physical therapist may also help evaluate the underlying cause of the problem and look at
muscle strength and balance and/or flexibility and gait analysis (watching a person walk or run).
Shoe orthotics may be useful if there is a gait problem, pelvic tilt, or leg-length discrepancy as a
potential cause of IT band syndrome.
It is rare that the conservative nonsurgical treatment fails to help. However, orthopedic surgery
may be an option for patients who fail conservative treatment. Arthroscopy can be used to find
the inflammation surrounding the iliotibial band and cut it away. The IT band itself can also
potentially be lengthened.
What stretches and exercises are beneficial for iliotibial band syndrome?
A. Hands are held on the waist, and the injured leg is crossed behind
the good leg. B. The arm on the same side as the injured leg sweeps
up and over as the hips are moved laterally toward the good side,
allowing a lateral bend at the waist. There should be no twisting with
this stretch and no need to touch the foot of the injured leg.
What exercises should be avoided with iliotibial band syndrome?
Most people want to return to their activity of choice as soon as possible, but rest is an
important component of treatment. Running, cycling, squatting, and walking up or downhill can
aggravate the iliotibial band and delay healing. It is important for the patient to listen to their
body and try to appreciate what specific activity or range of motion causes the pain and try to
avoid it if possible.
What is the prognosis for iliotibial band syndrome? Can iliotibial band syndrome be
prevented?
Most patients recover from iliotibial band syndrome, but it can take from weeks to months to
return to full activity without pain. Patience is required for optimal results.
Understanding the importance of symmetry in the body is helpful in preventing iliotibial band
syndrome. When activities alter that symmetry, symptoms may occur.
Symptoms can occur in runners who always run in the same direction on an indoor track or who
always run on the same side of a banked road. This causes an artificial tilt to the pelvis and
increases the risk of developing inflammation and pain. When running indoors, it is wise to
change directions when running longer distances. Some tracks have the runners change
directions every few minutes while others change direction on alternate days. While running
toward traffic is an important safety strategy, finding a way to run on the opposite side of the
street safely may minimize the risk of developing iliotibial band syndrome.
Bicyclists are at risk for iliotibial band syndrome if they tend to pedal with their toes turned in,
which can cause abnormal stretching of the iliotibial band at the knee. Being aware of pedaling
technique may minimize the risk of developing symptoms.
Keeping muscles and other structures stretched is an important part of prevention of many
musculoskeletal injuries, including iliotibial band syndrome
Where can people find more information about iliotibial band syndrome?
Iliotibial band syndrome is a common runner's affliction. Often a local running store will be able
to provide information about the signs and symptoms of the injury, including area health care
professionals who can help runners and other athletes.
REFERENCES:
Lavine, R. "Iliotibial Band Friction Syndrome." Curr Rev Musculoskelet Med. 3.1-4 Oct. 2010:
18-22.
Strauss, E.J., et al. "Iliotibial Band Syndrome: Evaluation and Management." J Am Acad Orthop
Surg. 19.12 Dec. 2011.
Last Editorial Review: 4/25/2012