Iliotibial band syndrome
- Jonathan Jackson, MD
Jonathan Jackson, MD
- Assistant Professor of Family Medicine
- Uniformed Services University of the Health Sciences
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Iliotibial band syndrome (ITBS) is an overuse injury of the lateral knee that occurs primarily in runners and was first described in 1973 . Pain develops where the iliotibial band (ITB) courses over the lateral femoral epicondyle (LFE), just proximal to the lateral joint line.
This topic will review the epidemiology, risk factors, clinical presentation, and treatment of ITBS. Undifferentiated knee pain and common causes of such pain are discussed separately. (See "Overview of running injuries of the lower extremity" and "Patellofemoral pain" and "Meniscal injury of the knee" and "Anterior cruciate ligament injury" and "Physical examination of the knee".)
Overall rates of iliotibial band syndrome (ITBS) vary from 2 to 25 percent in physically active individuals; the syndrome has not been reported in those who do not exercise [2,3]. ITBS is the second most common cause of knee pain due to overuse after patellofemoral dysfunction [4-6]. The problem is most common in runners, military personnel, and cyclists, but has also been described in Nordic skiers, soccer players, and other athletes [1-3,7,8]. Based upon limited observational studies, ITBS affects approximately 1.6 to 12 percent of runners [2,4-7,9]. The relative incidence among runners has increased over the past three decades for unknown reasons [2,6,9]. Up to 50 percent of cyclists experience knee pain [10,11]. In one observational study of 254 cyclists over six years, 24 percent of the cyclists presenting to a sports medicine clinic for knee pain were diagnosed with ITBS . Competitive cyclists who are frequently pedaling against high resistance may be at higher risk.
The iliotibial band (ITB) is a fibrous band that runs longitudinally along the lateral aspect of the thigh from its origin at the iliac crest to the proximal tibia (figure 1). Proximally, the tensor fascia lata, gluteus maximus, gluteus medius, and vastus lateralis all have connections to the ITB. The ITB has broad attachments to multiple structures at the lateral knee, including the quadriceps-patella-patellar tendon complex, the lateral femoral epicondyle (LFE), and the biceps femoris muscle-tendon-fibula complex. Distally, the ITB courses over the LFE, before inserting at Gerdy’s tubercle at the anterolateral tibia just below the knee joint line (picture 1) [12-14].
BIOMECHANICS AND PATHOPHYSIOLOGY
The iliotibial band (ITB) is thought to assist with knee extension when the knee is near terminal extension, and with knee flexion once the knee is flexed beyond 30 degrees (figure 2) [2,15,16]. The ITB also provides lateral knee stability .
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- BIOMECHANICS AND PATHOPHYSIOLOGY
- RISK FACTORS
- CLINICAL FEATURES
- Patient presentation
- Physical examination
- DIAGNOSTIC IMAGING
- INDICATIONS FOR ORTHOPEDIC REFERRAL
- DIFFERENTIAL DIAGNOSIS
- Acute phase: Symptom control
- Subacute phase: Correct strength and mobility deficits
- Chronic phase
- Adaptation phase: Return to sport
- FOLLOW-UP CARE
- SUMMARY AND RECOMMENDATIONS