The iliotibial band (ITB) is a structure composed of tough fibrous tissue that extends down the outside of the thigh, specifically from the upper portion of the hip bone (the iliac crest) to the lower portion of the knee joint (the tibia).1 Being able to walk and run with ease requires an intact iliotibial band. However, overuse of the knee joint, which is common in athletes, can cause it to become inflamed. Inflammation can result in lateral (outer) knee pain as well as reduced mobility, the two key features of iliotibial band syndrome.2
Iliotibial band syndrome can reduce athletic performance and prevent athletes from participating in their sport.3 The persistence of pain and time for the injury to resolve varies per person, typically extending from weeks to months. Luckily, at-home strategies such as rest and stretching are often sufficient for recovery, with surgery rarely being necessary. Though recovery is not necessarily rapid, athletes can generally always return to their sport, and physiotherapy can help prevent more injuries going forward.2
Causes of iliotibial band syndrome
The direct cause of iliotibial band syndrome is not completely understood, but it is thought that many factors play a role in the development of the condition. A traditional theory suggests that iliotibial band syndrome develops during physical activity when friction builds between the iliotibial band and the fatty tissue beneath the lateral femoral epicondyle, a part of the femur (thigh bone) where a ligament attaches. Hence why the condition is sometimes referred to as iliotibial band friction syndrome. A newer theory on the cause of iliotibial band syndrome proposes that the condition results from flexion (bending) of the knee joint, where the iliotibial band compresses against the lateral femoral epicondyle, irritating surrounding fatty tissue. As this fatty tissue can contain many nerves, it can be painful.1,4
Despite debate on the underlying mechanism of iliotibial band syndrome, it is clear that the condition results from overuse of the knee joint. Whilst all athletes are more vulnerable to the condition, runners and cyclists are particularly susceptible to being diagnosed with iliotibial band syndrome, due to the key role that the knee joint plays in these activities. These sports not only can cause iliotibial band syndrome, but can also exacerbate its signs and symptoms.¹
Signs and symptoms of iliotibial band syndrome
Lateral (outer) knee pain, often described as a sharp pain or burning sensation, is the predominant feature of iliotibial band syndrome. This pain can radiate beyond the knee, both above and below it. The severity of pain can vary from person to person. In mild cases the pain may be resolved with rest only. Persistent physical activity and delays in treatment can also worsen the pain.2,5
A popping sensation is also sometimes described with attempts to move the knee.2 Ultimately, iliotibial band syndrome can make moving the knee difficult due to the associated discomfort. Therefore, signs and symptoms of the condition tend to be most apparent with physical activity.2
Management and treatment for iliotibial band syndrome
Iliotibial band syndrome can typically be treated without surgical interventions with at-home treatment plans involving pain management and exercises. However, in the severe and rare cases where the condition persists chronically, or conservative management is unsuccessful, surgery may be considered.2
Treatment for iliotibial band syndrome typically begins with the aim of reducing inflammation of the iliotibial band since this may be responsible for most of the pain and subsequent lack of mobility.4
Soon after the injury occurs applying ice to the area may provide some immediate relief to inflammation and pain.6
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which can be taken orally, are often a first-choice pharmaceutical anti-inflammatory treatment. Corticosteroids delivered through the skin may sometimes be used too. A physician can modify the dose of medication according to the severity of the pain.4
Physiotherapy advice and treatment can be critical for promoting recovery following an injury, but also in helping athletes safely return to activity, reducing the chance of the injury recurring. Resting, stretching, and modification to exercise are key components of physical therapy.2
Resting is usually the first phase of treatment and is necessary for healing, preventing further irritation to, and restoring the, iliotibial band. In most cases, depending on the severity of the injury, two to six weeks of rest is sufficient.2
After an initial period of rest, daily stretching exercises can be integrated into the recovery regime. A clinician can tailor this depending on your levels of pain and how much your mobility is reduced.2 These stretching exercises can help improve the range of motion, strengthening the tensor fascia latae (one of the outer thigh muscles), hip muscles, and gluteal (buttock) muscles.⁷
Foam rolling is a self-massaging technique which involves using a tool to massage an injured area. This technique can enhance the muscle-strengthening effects of stretching and may be integrated into a stretching regime by a clinician.7,8
To return to previous exercise levels, a gradual approach is important. A clinician can help in implementing this approach, as well as provide strategies to help prevent injuries from occurring in the future.2
Surgery is rarely needed in the treatment of iliotibial band syndrome and is reserved for cases which persist chronically or where conservative management is unsuccessful. Arthroscopy, transection of the iliotibial band, and iliotibial band bursectomy are all surgical techniques previously used in treating iliotibial band syndrome.2
Arthroscopy is a keyhole surgery which can be used to mend problems with the knee joint and has been shown to promote recovery in those resistant to conservative treatment. This procedure has been associated with a high proportion of patients returning to sports post-surgery.2
Transection of the iliotibial band involves cutting the iliotibial band where it passes over the lateral femoral epicondyle. Whilst there is little information on rates of returning to sports post-surgery, the procedure is associated with high rates of patient satisfaction.2
Iliotibial band bursectomy involves the removal of bursae (fluid-filled sacs) from the iliotibial band and can reduce pain, enhance mobility, and help patients return to sport.2,9
Diagnosis of iliotibial band syndrome is typically made by taking the patient’s history and a physical examination.4 History taking can help identify the cause of the injury, understand the signs and symptoms, and evaluate the impact of the condition on your day-to-day life.4
Physical examination can involve a clinician feeling around the knee region to check for pain. The Ober’s test may also be performed, which involves a clinician moving the leg to produce hip abduction (movement of the leg away from the body). The test can assess the ability of the iliotibial band to be stretched.4 For runners specifically, the Noble’s test may be performed, where a clinician applies pressure to the knee as it is extended (straightened).1
In a minority of cases, magnetic resonance imaging (MRI) of the injured area may be used to rule out other conditions.
Other causes of lateral knee pain should be ruled out to confirm a diagnosis of iliotibial band syndrome. These causes include:
- Lateral meniscus lesions
- Lateral synovial plica syndrome
- Distal femoral bone stress injury
- Gluteal tendinopathy
- Lumbar radiculopathy1
How can I prevent iliotibial band syndrome?
Preventing iliotibial band syndrome relies on ensuring that the knee joint is not being overused, meaning that periods of rest should follow exercise. As well as this, muscle strengthening exercises can help make you less susceptible to injury.3
How common is iliotibial band syndrome?
Iliotibial band syndrome is common, predominantly in athletes. with the condition being responsible for up to one in five injuries of the lower limb.⁴
Who is at risk of iliotibial band syndrome?
Anyone engaging in repetitive physical activity is at an increased risk of iliotibial band syndrome. Athletes, particularly runners and cyclists, are vulnerable to this condition.¹
What can I expect if I have iliotibial band syndrome?
You will likely experience lateral (outer) knee pain and may face difficulties with mobility. As you recover, expect to not be able to engage in the physical activities you were participating in previously and take time to routinely rest and stretch.2
Does iliotibial band syndrome go away on its own?
Whilst iliotibial band syndrome doesn’t go away on its own, weeks of physical therapy and pain management often lead to resolution, with surgery rarely being needed.2
When should I see a doctor?
See a doctor as soon as possible following an injury to confirm a diagnosis and begin treatment. The sooner the treatment is commenced, the sooner full recovery can be achieved.2
Iliotibial band syndrome is a common overuse injury of the knee joint, frequently occurring in athletes.It is characterised by lateral knee pain and difficulty in moving the knee joint. Whilst it can prevent one from participating in their usual physical activities, at-home therapies, such as physiotherapy advice, rest, and stretching, are often successful in treating the condition and preventing it from recurring, allowing you to eventually return to usual movement and sports. Surgery is rarely necessary.
- Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The iliotibial band: a complex structure with versatile functions. Sports Medicine. 2022; 52(5): 995-1008. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023415/
- Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. Journal of Sports Medicine. 2013; 2013: 367169. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590904/
- Shamus J, Shamus E. The management of iliotibial band syndrome with a multifaceted approach: a double case report. International Journal of Sports Physical Therapy. 2015; 10(3): 378-390. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458926/
- Lavine R. Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine. 2010; 3(1-4): 18-22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941581/
- Bolia IK, Gammons P, Scholten DJ, Weber AE, Waterman BR. Operative versus nonoperative management of distal iliotibial band syndrome: where do we stand? Arthroscopy, Sports Medicine, and Rehabilitation. 2020; 2(4): 399-415. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451906/
- Fredericson M, Adam W. Practical management of iliotibial band friction syndrome in runners. Clinical Journal of Sports Medicine. 2006; 16(3): 261-268. Available from: https://pubmed.ncbi.nlm.nih.gov/16778549/
- Pepper TM, et al. The immediate effects of foam rolling and stretching on iliotibial band stiffness: a randomized controlled trial. International Journal of Sports Physical Therapy. 2021; 16(3): 651-661. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169023/
- Wiewelhove T, et al. A meta-analysis of the effects of foam rolling on performance and recovery. Frontiers in Physiology. 2019; 10: 376. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465761/
- Chatra PS. Bursae around the knee joints. Indian Journal of Radiology and Imaging. 2012; 22(1): 27-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354353/