Iliotibial band syndrome

Last reviewed: 4 Sep 2022
Last updated: 22 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • sharp or burning pain superior to the lateral joint line
  • positive Noble test
  • positive Ober test
  • positive modified Thomas test
More key diagnostic factors

Other diagnostic factors

  • reduced hip abductor muscle strength
  • genu varum (bow leg)
  • hindfoot and forefoot 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 edema
  • crepitation
Other diagnostic factors

Risk factors

  • athlete
  • preexisting iliotibial band 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 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
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • MRI of knee
  • ultrasound
More investigations to consider

Treatment algorithm

ACUTE

pain and inflammation

ONGOING

resolved pain and inflammation

refractory to conservative treatment

Contributors

Authors

Bob Baker, PT, PhD, MBA, OCS
Bob Baker

Rehabilitation Services Manager

NorthBay Healthcare

Fairfield

CA

Disclosures

RLB declares that he has no competing interests.

Jenson C. Mak, PhD, FRACP, FAFRM, FACP, MBBS
Jenson C. Mak

Rehabilitation Fellow

University of Sydney

Sydney

Australia

Disclosures

JCM declares that he has no competing interests.

Michael Fredericson, MD, FACSM
Michael Fredericson

Professor of Orthopaedic Surgery

Stanford Medical Center

Stanford University

Stanford

CA

Disclosures

MF declares that he has no competing interests.

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).

  • Iliotibial band syndrome images
  • Differentials

    • Biceps femoris tendinopathy
    • Degenerative joint disease
    • Lateral collateral ligament (LCL) sprain
    More Differentials
  • Guidelines

    • Practical management of iliotibial band friction syndrome in runners
    More Guidelines
  • Videos

    Knee examination

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer