Iliotibial band friction syndrome (ITBFS) 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.
ITBFS 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 underlying tissue.
Causes of the excessive friction include:
Incorrect training technique
Increasing distance run or cycling too quickly
Equipment (ie, bicycle) that is not properly fit to the user
Wearing improper shoes for a sport or athletic activity
Using damaged or worn out equipment or footwear
Failing to stretch properly
Muscle imbalances due to not strengthening opposing muscles (such as the quadriceps and hamstrings)
Risk factors for developing ITBFS include:
A short, tight IT band
A very prominent lateral femoral epicondyle (bony structure on the outer side of the knee)
Problems related to the foot or hip
Inward rotation of the leg
Legs of different lengths
Certain sports with repetitive motions, such as running and cycling
Running up and down hills
Symptoms of ITBFS include:
Dull aching or burning sensation on the outside of the knee during activity
Sharp stabbing pain on the outside of the knee during activity
The pain may be localized. It generally radiates around the outside of the knee and/or up the outside of the thigh. Pain typically starts as minor discomfort. It can then worsen progressively. Snapping, creaking, or popping may be present when the knee is bent and then straightened. There is usually no swelling.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis is based on these factors:
Pain around the lateral femoral epicondyle
Tenderness when pressure is applied to this area
Pain occurs when going from a straight leg to a bent knee
Tests may include:
Ober's test—determines the tightness of the ITB
Renne's test—specifies the area of pain while full weight is placed on the leg
Noble's test—determines the area of pain while the leg is flexed at a certain angle
Treatment depends on the cause.
Treatment may include:
Rest—restriction from activities that cause pain.
Heat or ice—application of heat, ice (generally ice is applied after activity; heat may be used before exercise to loosen muscles and soft tissues)
Exercise—may include stretching to lengthen the ITB and strengthening of the quadriceps and hamstrings can correct muscle imbalances
Correct technique—evaluating and correcting running, cycling, and weight-training techniques
Orthotics—custom orthotic supports to correct foot problems
Medications—anti-inflammatory medications and/or local cortisone injections
Surgery—only for extreme cases where other treatment options have failed
Avoiding the causes of ITBFS is the best way to prevent it. This can include:
Learn proper training techniques.
Wear appropriate shoes for each sport.
Replace athletic shoes as they show signs of wear.
Be aware of running surfaces.
Use properly-fitted equipment.
Increase mileage run and weight lifted gradually. When lifting weights do small increments each day.
Strengthen quadriceps and hamstrings.
Stretch the ITB.
See a foot specialist for evaluation and orthotics, if necessary.
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