Iliotibial Band (ITB) Syndrome
Lateral knee pain where the ITB compresses tissue over the lateral femoral epicondyle at about 30° of knee flexion.
Mechanism: teach the current model
- Old theory: friction as the band slides over the epicondyle.
- Current theory: compression. The ITB is stiff and largely non-extensible. Pain arises from compression of the richly innervated fat and connective tissue beneath it.
Why it matters
ITB stretching is unlikely to work, whereas hip abductor strengthening targets the actual mechanism.
Who
Distance running (hills, cambered roads, high mileage), cycling (saddle height, cleat position), rowing.
Risk factors
- Training: rapid mileage increase, downhill running, cambered surfaces, poor recovery
- Biomechanical: weak hip abductors (especially gluteus medius), excessive hip adduction, knee internal rotation, rearfoot eversion, leg length discrepancy, genu varum
- Equipment: worn footwear, poor bike fit
Presentation
- Lateral knee pain 2 to 3 cm above the joint line, with point tenderness at the lateral epicondyle
- Pain at a predictable point in a run (“always at 3 km”)
- Worse downhill, on stairs, and with repetitive flexion
- Noble compression test: compress over the epicondyle while extending the knee from 90°
- Ober’s test may show ITB or TFL tightness
Management
| Approach | Verdict |
|---|---|
| Load management (cut volume, avoid hills and camber) | First-line |
| Hip abductor and external rotator strengthening | Cornerstone |
| Gait retraining (cadence, step width) | Effective |
| Myofascial release, foam rolling | Short-term symptom relief |
| ITB stretching | Little evidence of benefit |
| Corticosteroid injection | Short-term only, for recalcitrant cases. Avoid repeats |
| Surgery | Rare, refractory cases |
Prognosis
Good. Most runners improve within 6 to 12 weeks of load management and strengthening.
References
- Strauss et al., J Am Acad Orthop Surg 2011, doi:10.5435/00124635-201112000-00003
- Conservative treatment of ITB syndrome in runners, Phys Ther Sport 2022, doi:10.1016/j.ptsp.2021.12.006
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.