A 21-year-old male long-distance runner in training for an upcoming marathon presents with left lateral knee and thigh pain. He recently increased his level of training to runs of 8 to 13 km (5 to 8 miles) approximately 4 times a week. The patient first noted the pain upon completion of a vigorous 13-km (8-mile) run. Physical examination is significant only for right lateral knee pain throughout range-of-motion testing and exacerbation of this pain with direct pressure on the lateral femoral epicondyle region.
Athletes with ITBS complain of a sharp or burning pain roughly 2 cm superior to the lateral 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.  Other presentations include diffuse pain over the lateral aspect of the knee. Patients often note that the pain is aggravated while running down hills, lengthening their stride, or sitting for long periods of time with the knee in the flexed position.  Proximal ITBS is a condition that involves stress to the iliotibial band origin at the iliac crest.