Iliotibial Band Syndrome (ITBS) is generally regarded as an overuse injury that affects the lateral aspect of the thigh. The condition commonly occurs in running and cycling due to the repetitive flexion of the knee at approximately 30 degrees. The Iliotibial Band extends from the tensor fascia latae distally in the lateral leg and inserts on the lateral aspect of the tibia. The etiology of ITBS may be due to an independent variable, but in most cases the condition is brought on by overstraining and multifactorial events such as biomechanical errors, improper footwear and variations in plantar surface angles, functional overpronation (malalignment) and/or inflexibility of the ITB and abductor/adductor muscle imbalances which may all lead to dysfunction. The condition is often exacerbated with continued participation in repetitive activities that employ limited knee flexion such as jogging. In order to adapt to the painful condition, individuals with ITB Syndrome will often externally rotate their hip, internally rotate their lower leg, and pronate their foot. This present’s additional concern as gait disturbance can corrupt the kinetic chain leading to inflammation in other regions.

ITB Syndrome has been associated with excessive frictional forces between the tract and the lateral femoral epicondyle. This friction results in an inflammation response and pain experienced over the lateral femoral condyle. Recent literature has challenged the theory that the IT band slides over the lateral femoral epicondyle. In a report published in the Journal of Science and Medicine in Sport (Sept. 06) Fairclough et al. suggest that based on the tissue architecture the inflammation of the tract or bursa is not likely. He presents three reasons 1) the IT band is not a discrete structure, but a thickened part of the fascia latae which envelops the thigh, 2) it is connected to the linea aspera by an intermuscular septum and to the supracondylar region of the femur including the epicondyle by coarse, fibrous bands clearly visible by dissection or MRI and 3) a bursa is rarely present, but may be mistaken for the lateral recess of the knee. Based on these details it is suggested that the current assumed cause, forward and backward frictional force during the flexion and extension of the knee, is unlikely, although slight medial-lateral movement can occur. Fairclough et al suggests that the cause of pain is associated with increased compression of a highly vascularized and innervated layer of fat and loose connective tissue that separates the IT band from the epicondyle. This assumption places the cause of the injury on impaired function of the hip musculature suggesting management strategies require emphasis on improving hip biomechanics to prevent a chronic condition from occurring.

A supportive research trial published in the Journal of Anatomy compared anatomical and mircoscpical evaluations on cadavers and MRI’s of asymptomatic volunteers to gain better understanding of IT band compression. Consistent with the aforementioned, the IT band in the cadavers was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. No bursa was present in the cadavers or volunteer subjects. Under magnetic resonance IT band compression occurred at 30 degrees of knee flexion due to tibial rotation, but moved laterally in extension. The researchers suggest that the action creates the illusion of movement, because of changing tension in IT band anterior and posterior fibers during knee flexion. Again, IT band overuse injuries may be more likely associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.

No matter what the actual cause the first step to treating the syndrome is removing the stimulus of irritation, which is most often repetitive leg movement at 30 degrees of flexion. Following diagnosis via clinical exam, acute management can include ice and non-steroidal anti-inflammatory medication, combined with strengthening and stretching therapies and activities to reduce myofascial restriction such as compression rolling and acupressure at trigger points. It is important to strengthen the hip adductors, gluteus maximus, and tensor fascia latae and address any hip muscle imbalances. Stretching the ITB, hip flexors, and gluteus maximus is central to rehabilitation. Orthotics may be helpful and foot overpronation must be corrected. Cortizone injection at the lateral femoral condyle may be necessary in persistent cases.

Return to repetitive activities can occur once cleared by the appropriate medical professional. As mentioned earlier, overstraining/training are associated with IT band syndrome, so the exercise prescription should be reviewed to assess volume and intensity changes that may be a contributing cause. For runners, it is important to avoid any downhill running, as it predisposes the runner to iliotibial band syndrome because the knee flexion angle at the footstrike is reduced. Whereas running at a faster pace (sprints) on a leveled surface may be utilized as they are less likely to cause ITB syndrome because at footstrike the knee is flexed beyond 30 degrees. In most cases, IT band syndrome can be managed in a relatively short period of time with routinely applied therapeutic modalities.