Iliotibial Band Syndrome

What Is IT Band Syndrome?

Iliotibial band syndrome (ITBS) is an overuse injury causing pain on the outer side of the knee. The iliotibial band is a thick band of tissue running from the hip to below the knee. ITBS is one of the most common causes of lateral knee pain in runners and cyclists.¹

Anatomy

IT band runs from hip to tibia
Crosses the lateral femoral epicondyle at the knee
Repetitive friction causes irritation
Pain typically at ~30 degrees knee flexion

Symptoms²

Sharp or burning pain on outer knee
Pain worse during activity (running, cycling)
Pain going downhill or downstairs
Clicking or popping sensation
May start mild, worsens with continued activity
Tenderness over lateral knee

Risk Factors

Rapid increase in training
Running on banked surfaces
Weak hip abductors
Leg length discrepancy
High weekly mileage
Worn-out shoes

Treatment³

Initial Management

Rest from aggravating activities
Ice application
NSAIDs
Activity modification

Rehabilitation

Hip strengthening (especially abductors)
IT band stretching
Foam rolling
Gait analysis and correction
Gradual return to activity

Other Options

Corticosteroid injection
Physical therapy
Surgery (rarely needed)

Prevention

Gradual training increases
Hip strengthening exercises
Proper footwear
Vary running surfaces
Adequate warm-up and cool-down

References

Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners—a systematic review. Phys Ther Sport. 2014;15(1):64-75.
Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19(12):728-736.
Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. J Sports Med. 2013;2013:367169.