When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Iliotibial band syndrome

Last reviewed: 5 Oct 2024
Last updated: 12 Jun 2024

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
Full details

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
Full details

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
  • lack of running experience
  • use of worn-out running shoes
  • downhill running, or 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
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • MRI of knee
  • ultrasound
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

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 exam

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

Use of this content is subject to our disclaimer