Iliotibial Band Syndrome

Aka: Iliotibial Band Syndrome, Iliotibial Band Tendonitis, Iliotibial Band Friction Syndrome

1. Epidemiology
   1. See also Running Injury
   2. Second most common knee problem in runners
      1. Accounts for 12% of Running injuries
2. 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
3. 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
4. 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
5. 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
6. Differential Diagnosis
   1. Plica Injury
   2. Popliteus Tendonitis
   3. Medial meniscus or lateral Meniscus Injury
7. 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
8. 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
9. Course
   1. Resolves within 6 weeks on consistent rehab program
10. References
    1. Arnold (2018) Am Fam Physician 97(8): 510-6 [PubMed]
    2. Khaund (2005) Am Fam Physician 71(8):1545-50 [PubMed]
    3. Fredericson (2000) Phys Sportsmed 28:53-68 [PubMed]