Iliotibial Band Syndrome (ITBS)

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What is Iliotibial Band Syndrome?

The Iliotibial band (IT band) is a thick ligament that runs along the lateral thigh from the iliac crest at the hip to the lateral proximal tibia in the lower leg.  The IT band is a abductor of the leg or helps in raising the leg out laterally. It also provides lateral leg stability and assist with both flexion and extension of the leg.

Who gets ITBS?

ITBS has only been found to be present in active individuals with an overall rate of 2-25%.  It is most common in runners and cyclists, but can occur in any type of athlete.  ITBS is an overuse injury that is chronic in nature and is not caused by acute trauma.  Some evidence reports runners with lower extremity alignment problems are at higher risk.  For example “knock kneed” or “bow legged” runners.  Other intrinsic factors are related to gait biomechanics, pelvic or core stability during running, as well as foot strike and arch patterns.

Other extrinsic risk factors include:

  • Running on uneven surfaces
  • Sudden increase in running or cycling mileage
  • Running in the same direction on a track
  • Long strides while running
  • Sudden increase in uphill cycling
  • Cycling in an improper position or improperly fitted bike

What are the symptoms?

The pain of ITBS is typically described as lateral knee pain, from where the ITB inserts over the lateral femoral condyle.  Initially the pain may only be present after exercise or physical activity, but as it progresses it can be present even during exercise and begin to impact performance and running times negatively.  Pain is often described as radiating up and down the side of the leg centered around the knee.  Athletes typically describe the pain as worse with leg extension such as a down stroke in cyclist or just prior or during a foot strike in runners.

How is it diagnosed and treated?

Diagnosis of ITBS is clinical meaning your doctor can make the diagnosis based on what you tell them and their findings on physical exam.  Imaging is not necessary for diagnosis, but if your doctor is concerned for a different diagnosis as well, imaging may be checked.  Initial treatment consists mainly of rest with no activity that reproduces your symptoms, icing the affected area and taking anti-inflammatory medications.  Depending on the patient and the cause of ITBS, mobility or strength may need to be addressed with home stretching exercises and in many cases formal physical therapy.  Therapy is focused on improving core strength, pelvic stability, and IT band flexibility.  There is limited evidence of benefits of using a foam roller of the ITB, but foam rolling focusing on the hip where it attaches to the tensor facia lata, gluteus muscles and vastus lateralis can often be beneficial for patients with tight IT bands.  A gait analysis to correct improper gait mechanics and foot strike patterns can also be very important for athletes who are hoping to return to their previous high level of activity or running.

When can I return to my sport?

Once the lateral knee pain has resolved, you may gradually increase your activity level.  Runners should avoid fast paced workouts and avoid downhill running initially.  Gradual return to running should follow the 10% rule with only increasing mileage 10% per week.  Cyclist may need to lower their seat height to avoid too much extension of the knee.  A bike fit evaluation can help.

By Lindsey Cala, MD and Mo Mortazavi, MD