II. Epidemiology

  1. See also Running Injury
  2. Second most common knee problem in runners
    1. Accounts for 12% of Running injuries

III. Risk factors

  1. Running downhill
  2. Running on hard surfaces (e.g. track)
  3. Running long distances
  4. Low body fat
  5. Varus malalignment
  6. Iliotibial band tightness
  7. Cross-over or supination during Running gait
  8. Excessive foot pronation and internal tibial rotation
    1. Not supported in studies

IV. Pathophysiology

  1. Microtrauma injury to iliotibial band
  2. Irritation of distal iliotibial band
    1. Excess friction, impingement at lateral femoral condyle (esp. with knee flexed to 20 to 30 degrees)
    2. Usually due to repetitive flexion and extension

V. Symptoms

  1. Initial characteristics
    1. Non-focal, diffuse lateral knee ache
  2. Later characteristics
    1. Sudden onset of sharp or stinging lateral Knee Pain
      1. Pain occurs during knee flexion (late swing phase)
      2. May require stopping Running
    2. Localized pain at fixed distance in miles
  3. Provocative: Repetitive knee flexion and extension
    1. Running downhill
    2. Stair climbing
    3. Running with longer stride
    4. Prolonged sitting with flexed knee
    5. Cycling

VI. Signs

  1. Provocative Tests
    1. See Noble's Test
    2. See Ober's Test
    3. Tenderness at 2 cm above (proximal to) lateral joint line
    4. Tenderness at lateral epicondyle of femur
    5. Pain on standing with knee flexed to 30 degrees
  2. Muscle Strength (weakness risk IT Band Syndrome)
    1. Knee extensors and flexors
    2. Hip abductors

VII. Differential Diagnosis

  1. Plica Injury
  2. Popliteus Tendonitis
  3. Medial meniscus or lateral Meniscus Injury

VIII. Management: Initial reduction in acute inflammation

  1. Acute measures
    1. RICE-M
    2. Cold Therapy
    3. NSAIDs for 10 days or less
    4. Relative rest until pain subsides
      1. Avoid repeated knee flexion and extension activity
      2. Cross-train with swimming
  2. Phonophoresis or Iontophoresis
  3. Iliotibial Band coticosteroid Injection
    1. Rarely indicated
    2. Consider for ambulatory pain longer than 3 days
    3. Inject maximally Tender Point over femoral condyle

IX. Management: After acute inflammation resolves

  1. Stretching (Described for affected right leg)
    1. Stand with right leg crossed behind left
    2. Lean forward and to left, with arms stretched out
  2. Gluteus medius strengthening (for affected right leg)
    1. Start after Stretching is no longer painful
    2. Standing position
      1. Right foot on raised platform (2-3 inches up)
      2. Left foot on floor
    3. Keep right knee locked in full extension
    4. Motion to repeat
      1. Slowly lower left foot to floor
      2. Raise left foot to Pelvis level
    5. Feel this in the right gluteus medius
  3. Modify Running training regimen
    1. Run on flat, non-banked surfaces
    2. Vary pace
    3. Gradually increase distance if no pain
    4. Stop Running for persistent pain
  4. Modify Bicycle fit
    1. Consider adjusting saddle height, pedal system
  5. Orthotics
    1. Adjust shoe for excessive lateral wear
  6. Surgical release of posterior 2 cm of IT Band
    1. Indicated if refractory to conservative measures
    2. Relieves pressure point over lateral epicondyle

X. Course

  1. Resolves within 6 weeks on consistent rehab program

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Related Studies

Ontology: Iliotibial Band Syndrome (C1262206)

Definition (MSH) An overuse injury causing lateral knee pain that results from repetitive friction of the iliotibial band over the lateral femoral epicondyle.
Concepts Disease or Syndrome (T047)
MSH D058745
ICD10 M76.3
SnomedCT 423849004, 202864001, 393604008
Italian Sindrome della fascia ileotibiale, Sindrome da frizione della fascia ileotibiale, ITB, Sindrome della bandelletta ileotibiale
Dutch iliotibiale band-frictiesyndroom, iliotibiale band; syndroom, syndroom; iliotibiale band, Iliotibiale-bandsyndroom, iliotibiale band-syndroom
French Syndrome de la bandelette ilio-tibiale, Syndrome de la bandelette iliotibiale, Syndrome de la bandelette de Maissiat, Syndrome de l'essuie-glace, Ressaut de la bandelette de Maissiat
German Iliotibial Band Friction Syndrome, Tractus-iliotibialis-Syndrom, Iliotibial-Band-Syndrom, Iliotibial Band Syndrome
Portuguese Síndrome de fricção de banda ilotibial, Síndrome da Banda Iliotibial, Síndroma da banda iliotibial
Spanish Síndrome de fricción de la banda iliotibial, síndrome de fricción de la bandeleta iliotibial (trastorno), síndrome de fricción de la bandeleta iliotibial, Síndrome de la Banda Iliotibial, Síndrome de la banda iliotibial
Japanese 腸脛靱帯摩擦症候群, 腸脛靱帯症候群, チョウケイジンタイマサツショウコウグン, チョウケイジンタイショウコウグン
English Iliotibial band friction syndrome (disorder), Iliotibial band friction syndrome, Iliotibial band syndrome, iliotibial band friction syndrome, iliotibial band friction syndrome (diagnosis), Syndrome, Iliotibial Band, Iliotibial Band Syndrome [Disease/Finding], Iliotibial Band Syndrome, Iliotibial band syndrome (disorder), iliotibial band; syndrome, syndrome; iliotibial band
Czech Syndrom lupavé kyčle, Coxa saltans, syndrom iliotibiálního pruhu
Korean 엉덩정강뼈 환 증후군
Hungarian Iliotibialis szalag dörzsölés szindróma, Iliotibialis szalag szindróma
Polish Zespół tarcia pasma biodrowo-piszczelowego, Zespół pasma biodrowo-piszczelowego, Zespół ITB
Norwegian Iliotibialbåndsyndrom, Løperkne, Tractus iliotibialis-syndrom