Iliotibial band syndrome - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Iliotibial band syndrome is the most common cause of lateral knee pain in runners.
Runners predisposed to this injury are typically in a phase of over-training and often have underlying weakness of the hip abductor muscle. Male runners may exhibit kinematic faults such as increased hip internal rotation and knee varus, and weakness in the external rotator muscles of the hip. Female runners may exhibit increased hip adduction and knee internal rotation, and abnormal iliotibial band strain and strain rate.
In the acute phase, treatment includes activity modification, ice, and nonsteroidal anti-inflammatory drugs. Offer a combined local anesthetic and corticosteroid injection if severe pain or swelling.
During the subacute phase, emphasis is on stretching of the iliotibial band and soft-tissue therapy for any myofascial restrictions.
The recovery phase focuses on a series of exercises to improve hip abductor strength and integrated movement patterns. The final return to running phase is begun with an every-other-day program, starting with easy sprints and avoidance of hill training with a gradual increase in frequency and intensity.

Impingement zone occurring at around 30° of knee flexion

From the personal collection of Dr J.C. Mak

Quick Reference

History & Exam
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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)
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
Impingement zone occurring at around 30° of knee flexion
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

Key Articles

Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006 May;16(3):261-8.[Abstract]
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]

Referenced Articles

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41. 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]
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