What is the anatomy involved in iliotibial band syndrome?
The iliotibial band (IT band) is a long flat tendon on the outside (lateral side) of the hip, thigh, and knee. The tensor fascia lata muscle and part of the gluteus maximus muscle attach to the tendon at the top (proximally). At the bottom (inferior) end, the tendon attaches to the top part of the shin bone (tibia) just below the knee joint to a bony prominence called Gerdy’s tubercle.
The iliotibial band slides over the bump (lateral epicondyle) on the outside (lateral side) of the knee when the knee is bent. This is where iliotibial band syndrome develops. When the knee is straight, the iliotibial band is in front of the bump. When the knee is bent, the iliotibial band is behind the bump. It slides over the bump when the knee is bent about 30 degrees.
There is a small fluid filled sack (bursa) between the iliotibial band and the underlying bump (lateral femoral epicondyle). There are bursa in many places in the body. They are flat fluid filled sacks that allow tendons to slide over bones with minimal friction.
What is iliotibial band syndrome?
Iliotibial band syndrome, also called IT band friction syndrome, is an overuse injury caused by excessive friction between the iliotibial band and lateral femoral epicondyle. The bursa may be inflamed as part of the syndrome.
What may predispose me to getting iliotibial band syndrome?
It is most often seen in runners, but it is also seen in cyclist and other athletes. There are several factors that may predispose you to getting iliotibial band syndrome:
-downhill running or running on banked surfaces
-bowed knees (genu varum)
-increases in training without conditioning
-tight iliotibial bands
How is iliotibial band syndrome diagnosed?
Iliotibial band syndrome often has the following characteristics:
-pain over the outside (lateral side) of the knee
-worsened by running, especially on hills and banked surfaces
-recent long runs or increases in training
-worsened by stairs
On physical exam, a physician may find the following:
-tenderness over the lateral epicondyle of the femur
- pain reproduced at 30 degrees of knee flexion while placing pressure on the lateral epicondyle and bringing the knee from flexion into extension
-bowed knees (genu varum)
-Iliotibial band tightness
-lack of findings on physical exam that would point towards another cause of the pain
Imaging is often not needed to make the diagnosis. However, if there is concern for other problems, x-rays and/or MRI may be ordered. X-rays would rule out underlying bone problems, such as arthritis and would also show the degree of “bowing” of the knees. MRI would rule out other potential causes of pain in this location, such as a lateral meniscus tear. An MRI may show inflammation in the bursa and lateral epicondyle with severe cases.
How can iliotibial band syndrome be prevented in athletes?
While ilitobial band syndrome may develop in running athletes despite attempts at prevention, certain measures may help to reduce the risk of developing iliotibial band syndrome. These include:
-regular stretching of the iliotibial band
-appropriate footwear and orthotics, particularly to correct foot pronation
-gradually increase training (avoid abrupt increases)
-avoid running downhill and on banked surfaces
What does nonsurgical treatment entail?
Nonsurgical treatment is almost always successful. This may be done independently or with the assistance of a physical therapist or athletic trainer. Treatment can be tailored to the individual based on the specific causes, but may include the following:
-decrease in intensity and mileage initially if possible
-correction of foot pronation with appropriate shoes and/or orthotics
-iliotibial band stretching, along with stretching of the calf, quads, and hamstrings
-this should be done religiously twice a day, doing 5 reps of each stretch, holding each one for 30 seconds
-avoid hills and cambered surfaces
-cross train with non-painful activities
-icing after exercise
-nonsteroidal anti-inflammatory medications (NSAID’s) such as ibuprofen
-strengthening of the hip abductors and external rotators
-gradual return to full activity once pain is controlled
This regimen will be effective in more than 90% of athletes. Return to full sport participation varies depending on the severity of the symptoms and the causes.
Do injections have a role?
Yes, a corticosteroid injection into the bursa underlying the iliotibial band may be considered. This decreases the inflammation and pain, but the other elements of nonsurgical treatment are still vital.
Does surgery have a role for iliotibial band syndrome?
As discussed above, nonsurgical treatment is almost always successful. It is extremely rare to treat the condition with surgery. However, it can be considered in the rare athlete that does not respond to other treatments. There are several described procedures. These are outpatient procedures. The options include taking out a small piece of the iliotibial band, lengthening the iliotibial band, or taking out the inflamed bursa. After surgery, the athlete uses crutches for a few days, and then gradually goes through a rehab program working on stretching and strengthening. Return to full sport is expected at 3-4 months.
Be sure to take a look at the following SportsMD iliotibial band stetching video.
Iliotibial Band Stretch - 2 Stretches.
If you suspect that you have iliotibial band syndrome, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor in your area, please visit our Find a Sports Medicine Doctor Near You section.
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John Diveris, MD
Diveris Orthopedics and Sports Medicine
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