Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the tissues located on the outer part of thigh and knee. It causes pain and tenderness in those areas, especially just above the knee joint. Iliotibial band syndrome is more common in runners and bicyclists.
Iliotibial band inflammation is an overuse syndrome that occurs often in long-distance runners, bicyclists, and other athletes who repeatedly squat. The iliotibial band syndrome may be the result of a combination of issues from poor training habits and poor flexibility of muscle and other mechanical imbalances in the body, especially involving the low back, pelvis, hips, and knees.
Pain on the outer side of the knee is the most common symptom of iliotibial band syndrome and is due to inflammation of the area where the band crosses back and forth at the femoral epicondyle. Initially, there may be sensations of stinging or needle-like pricks that are often ignored. This can gradually progress to pain every time the heel strikes the ground and finally can become disabling with pain when walking or when climbing up or down steps.
Some patients may feel a snapping or popping sound at the knee, and there may be some swelling either where the band crosses the femoral epicondyle or below the knee where it attaches to the tibia. Occasionally, the pain may radiate along the course of the IT band all the way up to the outer side of the thigh to the hip.
Often, the diagnosis of iliotibial band syndrome can be made by the patient’s story of symptoms. The patient describes the progression of lateral knee pain that is made worse when the heel strikes the ground. Physical examination is helpful because the area of pain can often be palpated with tenderness and swelling felt over the femoral epicondyle where the bursa or sac is located.
Dr. Backe may also look for leg-length discrepancy, muscle imbalance, and tightness in the legs and back. There is tenderness of the outer thigh just above the knee joint while the knee and hip joints themselves are normal to examination.
Usually, a full physical examination of the low back and legs, including the hips, knees and ankles, is performed to detect other potential causes of outer knee pain.
An MRI may be used to look for inflammation surrounding and beneath the iliotibial band. The MRI can also exclude other causes of outer knee pain. These include torn cartilage (lateral meniscus), sprained lateral collateral ligament, and tendon inflammation.
Initial treatment includes (RICE)
Anti-inflammatory medications, like ibuprofen (Advil, Motrin) and naproxen (Aleve), may be helpful. Please be aware that over-the-counter medications like these can have potential side effects and interactions with prescription medications and it is worthwhile asking a health-care professional or pharmacist whether they are safe to take.
Physical Therapy. The physical therapist may also help evaluate the underlying cause of the problem and look at muscle strength and balance and/or flexibility and gait analysis (watching a person walk or run). Shoe orthotics may be useful if there is a gait problem, pelvic tilt, or leg-length discrepancy as a potential cause of IT band syndrome.
Arthroscopy. It is rare that the conservative nonsurgical treatment fails to help. However, orthopedic surgery may be an option for patients who fail conservative treatment.