Iliotibial band syndrome

Iliotibial band syndrome is an overuse injury that results from excessive friction of the distal iliotibial band sliding over the lateral femoral epicondyle.

The most common cause of lateral knee pain in runners and cyclists.

Athletes predisposed to this injury are typically in a phase of over-training and often have underlying weakness of the hip abductor muscle.

Diagnosis is usually clinical, based on history and physical exam.

Management is largely conservative, guided by different phases of treatment, and includes activity modification, NSAIDs, corticosteroid injections, and stretching and strengthening exercises.

In refractory cases, surgery may be considered.

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]Tuite MJ. Imaging of triathlon injuries. Radiol Clin North Am. 2010 Nov;48(6):1125-35. http://www.ncbi.nlm.nih.gov/pubmed/21094402?tool=bestpractice.com [2]Muhle C, Ahn JM, Yeh L, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. 1999 Jul;212(1):103-10. http://www.ncbi.nlm.nih.gov/pubmed/10405728?tool=bestpractice.com [3]Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-8. http://www.ncbi.nlm.nih.gov/pubmed/16996312?tool=bestpractice.com [4]Ekman EF, Pope T, Martin DF, et al. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med. 1994 Nov-Dec;22(6):851-4. http://www.ncbi.nlm.nih.gov/pubmed/7856812?tool=bestpractice.com [5]Orchard JW, Fricker PA, Abud AT, et al. Biome­chanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May-Jun;24(3):375-9. http://www.ncbi.nlm.nih.gov/pubmed/8734891?tool=bestpractice.com [6]Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am. 2016 Feb;27(1):53-77. http://www.ncbi.nlm.nih.gov/pubmed/26616177?tool=bestpractice.com [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].