Definition

Iliotibial band syndrome (ITBS) is an overuse injury. It happens in the soft tissues in the lower thigh, near the outside of the knee. The iliotibial band (ITB) is a thick band of fibrous tissue. It runs from the hip down the outside of the thigh and attaches to the tibia. The tibia is the large bone of the lower leg.

Treatment depends on the severity of the injury.

Causes

ITBS is caused by repetitive friction or rubbing of the iliotibial band against the bone on the outer side of the knee. This excessive rubbing can irritate the ITB itself and/or the tissue underneath.

Causes of the excessive friction include:

Structural abnormalities, such as a short, tight IT band
Problems related to the foot, ankle, or hip
Opposing muscle imbalances, such as the quadriceps stronger than hamstrings
A very prominent lateral femoral epicondyle, the bony structure on the outer side of the knee
Inward rotation of the leg
Angle where knee flexes
Legs of different lengths
Bowlegs

Risk Factors

Factors that increase your risk of getting ITBS include:

Certain sports with repetitive motions, such as running and cycling
Incorrect training technique
Increasing distance run or cycling too quickly
Running up and down hills
Overtraining
Using damaged or worn out equipment or footwear
Wearing improper shoes for a sport or athletic activity
Athletic equipment that is not properly fit to the user, such as a bicycle

Symptoms

Symptoms of ITBS include:

Dull aching or burning sensation on the outside of the knee during or after activity
Sharp stabbing pain on the outside of the knee during or after activity
Pain that shows up in the hip, known as referred pain
Progressive, worsening pain
Snapping, creaking, or popping when the knee is bent and then straightened

Diagnosis

Your doctor will ask about your symptoms and medical history. In most cases, diagnosis can be made with a physical exam.

Tests may include:

Obers test—determines the tightness of the ITB
Rennes test—specifies the area of pain while full weight is placed on the bent leg
Nobles test—determines the area of pain while the leg is flexed at a certain angle

For images of the internal structure of your leg, your doctor may recommend anMRI.

Treatment

Talk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:

Acute Care

Rest

Your IT band will need time to heal. Avoid activities that place extra stress on the knee:

Do not do activities that cause pain. This includes running, jumping, and weight lifting using the leg muscles.
If normal walking hurts, shorten your stride.
Do not play sports until your doctor has said it is safe to do so.

Your doctor may recommend a foot orthotic to help control rototation of the foot. This will help stabilize the knee.

Cold

Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.

Pain Relief Medications

To manage pain, your doctor may recommend:

Over-the-counter medication, such as aspirin , ibuprofen , or acetaminophen
Prescription pain relievers
Corticosteroid injections

Recovery Steps

Heat

Use heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the muscle.

Stretching

When the acute pain is gone, start gentle stretching as recommended. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times. Stretch several times a day.

Strengthening

Begin strengthening exercises for your muscles as recommended.

Prevention

To reduce your chances of ITBS, take these steps:

Learning proper training techniques
Increasing mileage run gradually
Wearing appropriate shoes for each sport
Replacing athletic shoes as they show signs of wear
Being aware of running surfaces
Using properly fitted equipment
Strengthening quadriceps, hamstrings, and gluteal muscles

RESOURCES:

American Academy of Orthopaedic Surgeons

http://orthoinfo.org

American College of Sports Medicine

http://acsm.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association

http://www.coa-aco.org

The University of British Columbia Department of Orthopaedics

http://www.orthosurgery.ubc.ca

References:

Baker RL, Souza RB, et al. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PMR. 2011;3(6):550-561.

Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-459.

Iliotibial band (ITB) syndrome. http://www.ebscohost.com/dynamed. Updated September 5, 2012. Accessed May 3, 2013.

Strauss EJ, et al. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec;19(12):728-36.

Last reviewed March 2014 by Teresa Briedwell, PT, DPT, OCS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.