Iliotibial Band Friction Syndrome

Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury of the soft tissues in the lower thigh near the outside of the knee. The iliotibial band is a thick band of fibrous tissue that runs from the hip down the outside of the thigh, and attaches to the tibia (the large bone of the lower leg).

Causes

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:
  • Structural abnormalities
  • Incorrect training technique
  • Increasing distance run or cycled too quickly
  • Overtraining
  • Equipment (i.e., bicycle) that is not properly fit to the user
  • Wearing improper shoes for a sport or athletic activity
  • Using damaged or worn out equipment and footwear
  • Failing to stretch properly
  • Muscle imbalances due to not strengthening opposing muscles (such as the quadriceps and hamstrings)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • 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
  • Bowlegs
  • Inward rotation of the leg
  • Leg length discrepancy
  • Certain sports with repetitive motions (running and cycling)

Symptoms

Symptoms 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, but generally radiates around the outside of the knee and/or up the outside of the thigh. Pain typically starts as minor discomfort and worsens progressively. Snapping, creaking, or popping may be present when the knee is bent and then straightened. There is usually no swelling.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is based on two factors:
  • Pain around the lateral femoral epicondyle
  • Localized tenderness when pressure is applied to this area
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

Treatment depends on the cause.
Treatment may include:
Rest - restriction from activities that cause pain
Heat or Ice - application of heat, ice, and/or ultrasound by appropriate professionals
Exercise - stretching to lengthen the ITB; strengthening the quadriceps and hamstrings to 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

Prevention

Avoiding the causes of ITBFS is the best way to prevent it. This can include:
  • Learning proper training techniques
  • Wearing appropriate shoes for each sport
  • Replacing athletic shoes as they show signs of wear
  • Being aware of running surfaces
  • Using properly fitted equipment
  • Increasing mileage and weight lifted gradually
  • Strengthening quadriceps and hamstrings
  • Stretching the IT band
  • Seeing a foot specialist for evaluation and orthotics, if necessary