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St. Mary's Center for Orthopaedics

Iliotibial Band Syndrome

What is Iliotibial Band Syndrome (ITBS)?

Iliotibial band syndrome, or ITBS, is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins at the hip and extends to the outer side of the shin bone (tibia) just below the knee joint. The band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint.

Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle–the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result.

What are the Symptoms of ITBS?

The function of the iliotibial band is both to provide stability to the knee and to assist in flexion of the knee joint. When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

Common symptoms of ITBS include:

  • Pain over the outside of the knee joint
  • Swelling at the location of discomfort
  • A snapping or popping sensation as the knee is bent

Endurance athletes are especially prone to developing iliotibial band syndrome. Athletes who suddenly increase their level of activity, such as runners who increase their mileage, often develop iliotibial band syndrome.

What are the Treatment Options for ITBS?

Treatment of iliotibial band syndrome begins with efforts to control the inflammation. The initial phase is:

  • Rest

The first step to allowing inflammation to subside is to allow the joint to rest sufficiently. If cross-training does not cause discomfort, then it is reasonable.

  • Ice

Icing the area of discomfort can help to relieve the pain and settle the inflammation.

  • Anti-Inflammatory medications

Anti-inflammatory medications are frequently recommended to help relieve inflammation about the iliotibial band.

Once the acute symptoms are controlled:

  • Physical Therapy

Increasing strength and flexibility of the hip and knee is important.  Most rehabilitation protocols focus on both the hip and knee, as the iliotibial band requires the both joints to function normally.

  • Cortisone Injections

Cortisone injections into the area of inflammation may be an option, usually after the other treatments have failed to relieve the symptoms.

  • Surgery

Surgery is an option only in rare circumstances.

Prevent ITBS by strengthening the gluteus medius muscle near the hip. When it’s weak, another upper-leg muscle overcompensates and pulls on the ITB, causing pain along the outside of the leg, down to the knee.  This can be done through side-leg raises. When the gluteus medius muscle is weak, it causes the upper-leg muscle to overcompensate, pulling on the ITB and causing pain.

Overuse is the most common reason for injuries. Remember to take it slow when increasing the length and intensity of your runs. Running downhill is another factor in ITBS. If you go on a lot of downhill runs, you might consider running on more level ground, if possible.