Key diagnostic factors

sharp or burning pain superior to the lateral joint line (common)

• Athletes will often complain of a sharp or burning pain roughly 2 cm superior to the lateral knee joint line. The pain may radiate proximally or distally. In less severe cases, the pain begins after a reproducible time or distance and subsides quickly upon cessation of activities. With increasing severity, normal walking or sitting with the knee in flexion may become painful.

positive Noble's test (common)

• Physician applies pressure over the lateral femoral epicondyle while extending the knee from 90° of flexion. [6] Pain occurs when knee is flexed around 30°.

positive Ober's test (common)

• Normal tightness is when the leg can be passively stretched to a position horizontal but not completely adducted to a table. Moderate tightness is when the leg can be passively adducted to horizontal at best. If the leg cannot be passively adducted to horizontal, this is maximal tightness. [6] [26]

positive modified Thomas's test (common)

• The patient sits on the end of an examining table, rolls back to a supine position, and holds both knees to the chest. The patient holds the knee on the asymptomatic side close to the chest, keeping the hips on the table, and avoiding excessive posterior tilt (lumbar lordosis flattened). [27] The examiner then slowly lowers the affected limb towards the floor. [6] The test is positive if the femur is above the horizontal of the table (psoas), knee extends (rectus femoris and psoas), and abduction of the femur deepens the iliotibial band (tensor fascia lata and iliotibial band). [27] [28] [29]

Other diagnostic factors

reduced hip abductor muscle strength (common)

• Hip abductor muscle strength is evaluated in the side-lying position. Patients often compensate for weakness or inhibition of the gluteus medius with substitution of the tensor fascia lata, the quadratus lumborum muscles, or both. Hip abduction may be obtained by internal rotation and flexion of the hip owing to the tensor fascia lata, or hip elevation may be noted because the quadratus lumborum over-activates. A dysfunctional firing pattern may also be the source of chronic tensor fascia lata tightness. The normal firing pattern is gluteus medius, followed by tensor fascia lata, ipsilateral quadratus lumborum, and erector spinae. [6]

genu varum (bow leg) (common)

• Intrinsic factor that contributes to ITB tightness and muscle weakness (quadriceps and gluteus medius). [17]

hind-foot and fore-foot varum (common)

• Intrinsic factor that contributes to ITB tightness and muscle weakness (quadriceps and gluteus medius). [17]

pes cavus (high arch) (common)

• Intrinsic factor that contributes to ITB tightness and muscle weakness (quadriceps and gluteus medius). [17]

prominent lateral femoral epicondyle, tight iliotibial tract and tensor fascia lata (common)

• Repetitive irritation can lead to chronic inflammation, especially beneath the posterior fibres of the ITB, which are thought to be tighter against the lateral femoral epicondyle than the anterior fibres.

weak gluteus medius, gluteus maximus, and tensor fascia lata (common)

• Weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. Decreased ability to stabilise the pelvis and control hip abduction results in other muscles compensating, often leading to excessive soft-tissue tightness and myofascial restrictions. [13] [22] [23]

tightness and weakness in the quadriceps, iliotibial tract, and lateral retinaculum (common)

• Muscle weakness is a causative factor and compensatory responses may result in excessive soft-tissue tightness and myofascial restrictions. [13] [22] [23]

pain on sitting or walking (uncommon)

• Typically, athletes complain of lateral knee pain present on the onset of walking.

local oedema (uncommon)

• Local oedema may be noted at the distal iliotibial band (ITB), and thorough palpation of the affected limb may reveal multiple trigger points in the vastus lateralis, gluteus medius, and biceps femoris.

crepitation (uncommon)

• May occur when the knee is bent and then straightened.