Iliotibial Band Syndrome

Editor: Dr. Amy Spencer, PT, DPT, OCS, MTC, CSCS, CKTP - A Board Certified Clinical Specialist in Orthopedic Physical Therapy and Certified Manual Therapist. Owner and Physical Therapist, Specialized Physical Therapy in North Reading, MA.

The iliotibial band (ITB) is a thick band of fascia that crosses the hip joint and extends downward to insert on the kneecap (patella), shin bone (tibia), and hamstring (biceps femoris) tendon. The function of the iliotibial band is to provide both stability to the knee and to assist in bending or flexing the knee joint. Injury to the ITB is very common. Iliotibial band syndrome (ITBS) describes the pain caused by inflammation of the band as it crosses the outer knee. The ITB glides back and forth over the lateral femoral condyle as the knee bends and straightens. The bursa between the lateral femoral condyle and the ITB can become irritated and inflamed if the ITB starts to snap over the condyle with repeated knee motions like walking, running, or biking.

Causes of ITBS:

People often end up with ITBS from overdoing a certain activity. The repeated strain causes the bursa on the side of your knee to become inflamed. In some athletes, especially runners or cyclists, repetitive flexion and extension of the knee cause the distal iliotibial band to become irritated and inflamed. This will result in diffuse lateral knee pain. Endurance athletes are especially prone to developing ITBS. Athletes that increase their level of activity too quickly, such as runners who increase their mileage by too much, often develop ITBS. Anatomic factors such as leg length discrepancy, an abnormal pelvic tilt, and bowlegs (genu varum) may cause ITBS because of excess stretching of the ITB across the femoral condyle.

Symptoms of ITBS:

• Pain on the outside of the knee joint
• Swelling at the location of discomfort
• A snapping or popping sensation when you bend the knee
• Weakness in hip abduction (moving the leg out to the side)

Treatment of ITBS:

Most cases of Iliotibial Band Tendonitis (ITBS) can be treated with conservative physical therapy measure like rest, ice, anti-inflammatories and manual physical therapy. Surgery is rarely needed to treat ITBS. Ice, ultrasound, and Kinesio tape may be used to assist with decreasing any pain or swelling at the knee. Customized stretching with hip and knee strengthening exercises will help in restoring range of motion, muscle performance, and motor function. The focus of all physical therapy is to restore knee function, strength, and mobility.

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