Iliotibial Band Syndrome

What is iliotibial band syndrome (ITBS)?

Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the tissues causing inflammation at 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 with, but not limited to, runners and bicyclists.

Knee and ITB Anatomy:

The iliotibial band is a thick band of tissue that begins at the front of 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 called Gerdy’s tubercle.  Here it blends with the hamstring tendons on the outside of the knee. The thickened tissue is called the fascia lata. The muscles that insert into the proximal (upper) portion of this band are the tensor fascia lata and a portion of the gluteus maximus and gluteus medius muscles (muscle of the buttocks) .The thickened band down the outside of the leg is called the ilio-tibial band (ITB). At the distal portion of the band it splits to the inside of the knee into the ilio-patellar band and outside of the knee into the iliotibial tract. The function of the iliotibial (IT) band is to help stabilize the outside part of the knee through its range of motion.

Risk Factors:

    • A naturally tight or wide IT band
    • Weak hip muscles, particularly the buttocks
    • Over pronation (rolling in of the foot) or poor foot biomechanics
    • Leg-length discrepancy
    • Abnormal tilt to the pelvis or bowed legs

Common Signs and Symptoms of IT Band Syndrome

    • Initially, there may be sensations of stinging or needle-like pricks
    • Pain is worse at beginning of an exercise and lessens once warmed up
    • Pain that is felt most when the foot of the affected leg strikes the ground
    • Pain is worse with running down hills or stairs, on banked tracks, or next to the curb on the street
    • Pain, tenderness, swelling, warmth, or redness over the iliotibial band area above the joint of the outer knee
    • Presentation of a crackling sound when the tendon or bursa is moved or touched
    • As pain begins to worsen it may begin to travel up or down the thigh or leg
    • When pain becomes chronic, eventually it will hurt throughout the activity and worsening as the activity continues.
    • Pain may become severe to the point one will stop in the middle of training or competing
    • Pain can become disabling when walking or when climbing up or down steps

Treatment for Iliotibial Band Syndrome

First line of defense includes rest, ice, compression, and elevation (RICE).  If these treatments do not work, physical therapy may be needed to decrease the inflammation. A physical therapist will design a regime for you that will consist of specific flexibility and stretching. There are also treatments including ultrasound, iontophoresis, manual soft tissue mobilization and evaluatation of the underlying cause of the problem.   Treatments will be guided to address appropriate muscle strength, balance and/or flexibility and gait analysis. If there is a gait problem, shoe orthotics may be useful.  Also if there is a leg-length discrepancy, this can be addressed as well as it may be a potential cause of IT band syndrome.


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The treatment of iliotibial band friction syndrome. Noble CA. Br J Sports Med. 1979 Jun;13(2):51-4.

Iliotibial band friction syndrome. Kirk KL, Kuklo T, Klemme W. Orthopedics. 2000 Nov; 23(11):1209-14; discussion 1214-5; quiz 1216-7.

Iliotibial band syndrome: evaluation and management. Strauss EJ, Kim S, Calcei JG, Park D.   Am Acad Orthop Surg. 2011 Dec; 19(12):728-36.

Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears. Adams WB. Curr Sports Med Rep. 2004 Oct; 3(5):256-60.

If you are having pain in your leg or have been diagnosed with iliotibial band syndrome, please come see us for a free consultation to see how we can assist you in your recovery.  To request an appointment, click here, or call directly to one of our three locations during regular business hours:

Cool Springs: 615-224-9810
Shelbyville: 931-684-0027
Spring Hill: 931-489-2022

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