Iliotibial band syndrome

Overview

Iliotibial band syndrome (ITBS) is a common overuse injury that affects the outer part of the knee. It occurs when the iliotibial band, a thick band of connective tissue running from the hip to the shin, becomes tight or inflamed and rubs against the lateral femoral epicondyle (the outer part of the thigh bone near the knee). ITBS is especially common in runners, cyclists, and other athletes involved in repetitive lower limb movements. It is one of the leading causes of lateral knee pain in active individuals.

Causes

ITBS results from repeated friction of the iliotibial band over the lateral femoral condyle, usually during flexion and extension of the knee. Contributing factors include:

• Overuse: Repetitive knee motion, especially during running or cycling, can irritate the iliotibial band.

• Muscle imbalances: Weakness in the hip abductor or gluteal muscles can increase strain on the IT band.

• Poor biomechanics: Flat feet, overpronation, or leg length discrepancies can contribute to abnormal stress.

• Improper training: Sudden increases in activity, inadequate warm-up, or running on banked surfaces may lead to ITBS.

• Tight IT band: Limited flexibility in the band can predispose individuals to irritation and inflammation.

Symptoms

The hallmark symptom of iliotibial band syndrome is pain on the outer side of the knee. Other common symptoms include:

• Lateral knee pain: Sharp or burning pain typically worsens with activity, especially running downhill or climbing stairs.

• Tenderness: Localized tenderness or swelling over the lateral femoral epicondyle.

• Snapping sensation: Some may feel a snapping or popping sensation as the IT band moves over the bone.

• Pain with flexion: Discomfort usually increases around 30 degrees of knee flexion, where the IT band is most compressed.

Diagnosis

Diagnosis of ITBS is primarily clinical, based on the patient’s history and physical examination. Key diagnostic steps include:

• Physical exam: Palpation reveals tenderness on the outer knee. Provocative tests such as the Ober’s test or Noble’s compression test may reproduce symptoms.

• Imaging studies: MRI or ultrasound can be used to confirm inflammation of the IT band or exclude other knee pathologies, though not always necessary.

• Patient history: A history of increased physical activity, especially running, is a typical clue.

Treatment

Most cases of iliotibial band syndrome can be managed conservatively with non-surgical interventions:

• Rest: Reduce or temporarily stop aggravating activities to allow inflammation to subside.

• Ice therapy: Applying ice to the lateral knee can help reduce swelling and pain.

• Physical therapy: Stretching, foam rolling, and strengthening exercises for the hips and glutes are key components of recovery.

• NSAIDs: Non-steroidal anti-inflammatory drugs may provide short-term pain relief.

• Correct biomechanics: Addressing gait abnormalities and using orthotics or proper footwear can prevent recurrence.

• Corticosteroid injections: In resistant cases, an injection near the IT band may help reduce inflammation.

Prognosis

The prognosis for iliotibial band syndrome is generally excellent with proper treatment and activity modification. Most individuals recover fully within a few weeks to months, depending on severity. Persistent or recurrent cases may require more intensive physical therapy or biomechanical assessment. Preventive measures such as gradual training progression, proper footwear, and strength training can help avoid future episodes. Surgery is rarely needed and reserved for chronic, unresponsive cases.