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Iliotibial band syndrome

Last reviewed: 1 Apr 2025
Last updated: 29 Apr 2025

Summary

Definition

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
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • x-ray of knee
  • ultrasound of knee
  • MRI of knee
Full details

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

BB is an author of articles cited in this topic.

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 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).

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
  • 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 exam

    More videos
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