Last reviewed: 6 Apr 2021
Last updated: 07 Aug 2018



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

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

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 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

Treatment algorithm


Robert L. Baker

Research Physical Therapist

Emeryville Sports Physical Therapy




RLB declares that he has no competing interests.

Jenson C. Mak

Rehabilitation Fellow

University of Sydney




JCM declares that he has no competing interests.

Michael Fredericson

Professor of Orthopaedic Surgery

Stanford Medical Center

Stanford University




MF declares that he has no competing interests.

Peer reviewersVIEW ALL


Chief of Physical Medicine and Rehabilitation

Ann Arbor VA Medical Center

Ann Arbor



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).

Use of this content is subject to our disclaimer