- 0
Highlights & Basics
- Iliotibial band syndrome is an overuse injury that results from excessive friction of the distal iliotibial band sliding over the lateral femoral epicondyle.
- The most common cause of lateral knee pain in runners and cyclists.
- Athletes predisposed to this injury are typically in a phase of over-training and often have underlying weakness of the hip abductor muscle.
- Diagnosis is usually clinical, based on history and physical exam.
- Management is largely conservative, guided by different phases of treatment, and includes activity modification, NSAIDs, corticosteroid injections, and stretching and strengthening exercises.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Iliotibial band syndrome. Red mark indicates site of injury: insertion of the iliotibial band into and just proximal to the lateral femoral epicondyle. (BF: biceps femoris; GMAX: gluteus maximus; GT: greater trochanter; ITB: iliotibial band; TFL: tensor fasciae latae; VL: vastus lateralis)
Impingement zone occurring at around 30° of knee flexion
Male runner with iliotibial band syndrome. The femur may or may not exhibit increased internal rotation. The investigators did not report on the mechanism of increased hip internal rotation
Female runner with iliotibial band syndrome
Anatomy of iliotibial band. IT band, iliotibial band; Gluteus max, gluteus maximus; TFL, tensor fascia lata
Injection site for iliotibial band
Hip abduction in side-lying position with hip extended for posterior gluteus medius emphasis
Standing stretch exercise
Foam roll exercise
Demonstration of pelvic drop
Citations
Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006 May;16(3):261-8.[Abstract]
1. Tuite MJ. Imaging of triathlon injuries. Radiol Clin North Am. 2010 Nov;48(6):1125-35.[Abstract]
2. Muhle C, Ahn JM, Yeh L, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. 1999 Jul;212(1):103-10.[Abstract]
3. Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-8.[Abstract]
4. Ekman EF, Pope T, Martin DF, et al. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med. 1994 Nov-Dec;22(6):851-4.[Abstract]
5. Orchard JW, Fricker PA, Abud AT, et al. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May-Jun;24(3):375-9.[Abstract]
6. Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am. 2016 Feb;27(1):53-77.[Abstract]
7. Sher I, Umans H, Downie SA, et al. Proximal iliotibial band syndrome: what is it and where is it? Skeletal Radiol. 2011 Dec;40(12):1553-6.[Abstract]
8. van der Worp MP, van der Horst N, de Wijer A, et al. Iliotibial band syndrome in runners: a systematic review. Sports Med. 2012 Nov 1;42(11):969-92.[Abstract]
9. Kirk KL, Kuklo T, Klemme W. Iliotibial band friction syndrome. Orthopedics. 2000 Nov;23(11):1209-14.[Abstract]
10. Noble CA. Iliotibial band friction syndrome in runners. Am J Sports Med. 1980 Jul-Aug;8(4):232-4.[Abstract]
11. Linenger JMCC. Is iliotibial band syndrome overlooked? Phys Sportsmed. 1992 Feb;20(2):98-108.
12. Messier SP, Edwards DG, Martin DF, et al. Etiology of iliotibial band friction syndrome in distance runners. Med Sci Sports Exerc. 1995 Jul;27(7):951-60.[Abstract]
13. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002 Apr;36(2):95-101.[Abstract][Full Text]
14. Noehren B, Davis I, Hamill J. ASB clinical biomechanics award winner 2006 prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech (Bristol, Avon). 2007 Nov;22(9):951-6.[Abstract]
15. Sharma J, Greeves JP, Byers M, et al. Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times. BMC Musculoskelet Disord. 2015 May 4;16:106.[Abstract][Full Text]
16. Hutchinson LA, Lichtwark GA, Willy RW, et al. The iliotibial band: a complex structure with versatile functions. Sports Med. 2022 May;52(5):995-1008.[Abstract][Full Text]
17. Barber FA, Sutker AN. Iliotibial band syndrome. Sports Med. 1992 Aug;14(2):144-8.[Abstract]
18. Dahan R. Rehabilitation of muscle-tendon injuries to the hip, pelvis, and groin areas. Sports Med Arthrosc Rev. 1997;5:326-33.
19. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R. 2011 Jun;3(6):550-61.[Abstract]
20. Miller RH, Lowry JL, Meardon SA, et al. Lower extremity mechanics of iliotibial band syndrome during an exhaustive run. Gait Posture. 2007 Sep;26(3):407-13.[Abstract]
21. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000 Jul;10(3):169-75.[Abstract]
22. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006 Mar;208(3):309-16.[Abstract][Full Text]
23. Noehren B, Schmitz A, Hempel R, et al. Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. J Orthop Sports Phys Ther. 2014 Mar;44(3):217-22.[Abstract][Full Text]
24. Ferber R, Noehren B, Hamill J, et al. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010 Feb;40(2):52-8.[Abstract]
25. Hamill J, Miller R, Noehren B, et al. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). 2008 Oct;23(8):1018-25.[Abstract]
26. Miller RH, Meardon SA, Derrick TR, et al. Continuous relative phase variability during an exhaustive run in runners with a history of iliotibial band syndrome. J Appl Biomech. 2008 Aug;24(3):262-70.[Abstract]
27. Marais JV, Jansen van Rensburg A, Schwellnus MP, et al. Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study. Phys Sportsmed. 2024 Dec;52(6):568-78.[Abstract][Full Text]
28. Meardon SA, Campbell S, Derrick TR. Step width alters iliotibial band strain during running. Sports Biomech. 2012 Nov;11(4):464-72.[Abstract]
29. Jiménez Díaz F, Gitto S, Sconfienza LM, et al. Ultrasound of iliotibial band syndrome. J Ultrasound. 2020 Sep;23(3):379-85.[Abstract]
30. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15;71(8):1545-50.[Abstract][Full Text]
31. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006 May;16(3):261-8.[Abstract]
32. American College of Radiology. ACR appropriateness criteria: chronic knee pain. 2018 [internet publication].[Full Text]
33. Gupta P, Yadav D, Singh KK, et al. Iliotibial band friction syndrome: a common cause of lateral knee pain in long-distance runners. J Mar Med Soc. 2023;25(1):69-72.[Full Text]
34. Janda V. Muscle strength in relation to muscle length, pain and muscle imbalance. In: Harms-Ringdahl K, ed. Muscle strength (international perspectives in physical therapy). Edinburgh, UK: Churchill Livingstone; 1993.
35. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-9.[Abstract]
36. Ellis R, Hing W, Reid D. Iliotibial band friction syndrome: a systematic review. Man Ther. 2007 Aug;12(3):200-8.[Abstract]
37. Friede MC, Innerhofer G, Fink C, et al. Conservative treatment of iliotibial band syndrome in runners: are we targeting the right goals? Phys Ther Sport. 2022 Mar;54:44-52.[Abstract][Full Text]
38. Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. J Sports Med (Hindawi Publ Corp). 2013;2013:367169.[Abstract][Full Text]
39. Gunter P, Schwellnus MP. Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. Br J Sports Med. 2004 Jun;38(3):269-72.[Abstract][Full Text]
40. Arnal-Burró J, Vidal-Fernández C, Igualada-Blazquez C, et al. PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results. BMC Sports Sci Med Rehabil. 2023 Nov 10;15(1):151.[Abstract][Full Text]
41. Fredericson M, Guillet M, Debenedictis L. Innovative solutions for iliotibial band syndrome. Phys Sportsmed. 2000 Feb;28(2):53-68.[Abstract]
42. Distefano LJ, Blackburn JT, Marshall SW, et al. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. 2009 Jul;39(7):532-40.[Abstract]
43. Ayotte NW, Stetts DM, Keenan G, et al. Electromyographical analysis of selected lower extremity muscles during 5 unilateral weight-bearing exercises. J Orthop Sports Phys Ther. 2007 Feb;37(2):48-55.[Abstract]
44. Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait re-training emphasizing step rate manipulation. Int J Sports Phys Ther. 2014 Apr;9(2):222-31.[Abstract][Full Text]
45. Foch E, Reinbolt JA, Zhang S, et al. Associations between iliotibial band injury status and running biomechanics in women. Gait Posture. 2015 Feb;41(2):706-10.[Abstract]
46. Heiderscheit BC, Chumanov ES, Michalski MP, et al. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011 Feb;43(2):296-302.[Abstract][Full Text]
47. Noehren B, Scholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med. 2011 Jul;45(9):691-6.[Abstract][Full Text]
48. Barrios JA, Crossley KM, Davis IS. Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment. J Biomech. 2010 Aug 10;43(11):2208-13.[Abstract][Full Text]
49. Eng CM, Arnold AS, Lieberman DE, et al. The capacity of the human iliotibial band to store elastic energy during running. J Biomech. 2015 Sep 18;48(12):3341-8.[Abstract]
