Last reviewed: June 2018
Last updated: September  2016



History and exam

Key diagnostic factors

  • sharp or burning pain superior to the lateral joint line
  • positive Noble's test
  • positive Ober's test
  • positive modified Thomas's test

Other diagnostic factors

  • reduced hip abductor muscle strength
  • genu varum (bow leg)
  • hind-foot and fore-foot varum
  • pes cavus (high arch)
  • prominent lateral femoral epicondyle, tight iliotibial tract and tensor fascia lata
  • weak gluteus medius, gluteus maximus, and tensor fascia lata
  • tightness and weakness in the quadriceps, iliotibial tract, and lateral retinaculum
  • pain on sitting or walking
  • local oedema
  • crepitation

Risk factors

  • athlete
  • pre-existing iliotibial band (ITB) tightness
  • high weekly mileage
  • time spent walking or running on a track
  • interval training
  • muscular weakness of knee extensors, knee flexors, and hip abductors
  • leg-length discrepancies
  • step width
  • downhill running
  • lack of running experience
  • abrupt increase in running distance or frequency
  • long-distance running
  • running at an improper pace
  • use of worn-out running shoes
  • running on a cambered surface or slippery surface
  • knee varus in male runners
  • muscular weakness in hip external rotator muscles in male runners
  • excessive hip internal rotation in male runners

Diagnostic investigations

Investigations to consider

  • MRI of knee
  • ultrasound
Full details

Treatment algorithm


Authors VIEW ALL

Robert L. Baker

Research Physical Therapist

Emeryville Sports Physical Therapy




RLB declares that he has no competing interests.

Michael Fredericson

Associate Professor and Director

Physical Medicine & Rehabilitation Clinics

Stanford University




MF declares that he has no competing interests.

Robert L. Baker and Dr Michael Fredericson would like to gratefully acknowledge Jenson C. Mak, a previous contributor to this topic.


JCM declares that he has no competing interests.

Peer reviewers VIEW ALL


Chief of PM&R

Ann Arbor VA Medical Center

Ann Arbor



RW has been reimbursed by the University of Michigan for attending several conferences; RW has been paid an honorarium for speaking at the American Association of Neuromuscular and Electrodiagnostic Medicine national meeting. RW has been paid by NIOSH, the American Dental Association, and SmartHealth as a consultant and has received grant funding from the UAW/GM Health and Safety Board (over US$1 million).

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