Summary
Definition
Iliotibial band syndrome (ITBS) is an overuse injury that results from repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, and remaining tense in both positions. However, some functional anatomists and musculoskeletal radiologists consider ITBS a possible compression syndrome. The soft tissue involved may include the iliotibial band attachment into the lateral epicondyle of the femur, underlying adipose and bursal tissue, and distal ligamentous insertions into the Gerdy tubercle of the tibia.[1][2][3][4][5][6][Figure caption and citation for the preceding image starts]: 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)Baker RL et al. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am. 2016 Feb;27(1):53-77; used with permission [Citation ends].
History and exam
Key diagnostic factors
- history of athleticism
- sharp or burning pain superior to the lateral joint line
- positive Noble test
- positive Ober test
- positive modified Thomas test
Other diagnostic factors
- reduced hip abductor muscle strength
- genu varum (bow leg), hindfoot and forefoot varum, and pes cavus (high arch)
- prominent lateral femoral epicondyle
- swelling, local edema, or crepitations
Risk factors
- athlete
- high weekly mileage
- interval training
- muscular weakness of knee extensors, knee flexors, and hip abductors
- lack of running experience
- use of worn-out running shoes
- downhill running, or running on a cambered or slippery surface
- female sex
- preexisting iliotibial band tightness
- leg-length discrepancies
- step width and strain rate
- knee varus in male runners
- muscular weakness in hip external rotator muscles in male runners
- excessive hip internal rotation in male runners
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- x-ray of knee
- ultrasound of knee
- MRI of knee
Treatment algorithm
pain and inflammation
resolved pain and inflammation
refractory to conservative treatment
Contributors
Authors
Bob Baker, PT, PhD, MBA, OCS
Rehabilitation Services Manager
NorthBay Healthcare
Fairfield
CA
Disclosures
BB is an author of articles cited in this topic.
Jenson C. Mak, PhD, FRACP, FAFRM, FACP, MBBS
Rehabilitation Fellow
University of Sydney
Sydney
Australia
Disclosures
JCM declares that he has no competing interests.
Michael Fredericson, MD, FACSM
Professor of Orthopaedic Surgery
Stanford Medical Center
Stanford University
Stanford
CA
Disclosures
MF is an author of several articles cited in this topic.
Peer reviewers
Robert Werner, MD
Professor
Chief of Physical Medicine and Rehabilitation
Ann Arbor VA Medical Center
Ann Arbor
MI
Disclosures
RW has been reimbursed by the University of Michigan for attending several conferences and has been paid an honorarium for speaking at the American Association of Neuromuscular and Electrodiagnostic Medicine national meeting. RW has been paid by the National Institute for Occupational Safety and Health, 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).
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Biceps femoris tendinopathy
- Degenerative joint disease
- Lateral collateral ligament (LCL) sprain
More DifferentialsGuidelines
- Practical management of iliotibial band friction syndrome in runners
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Knee exam
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