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Iliotibial Band Syndrome

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Other Names

  • IT Band Syndrome
  • ITBS
  • Iliotibial Band Syndrome (ITBS)
  • Iliotibial Band Friction Syndrome (ITBFS)


  • This page refers to overuse injuries of the Iliotibial Band (ITB), most commonly termed iliotibial band syndrome (ITBS)


  • First described by Colson and Armour[1]
  • Later in more detail by Renne in 1975[2]


  • Incidence
    • Ranges from 1.6% to 52% depending on the population referenced[3]
    • Among runners, incidence is estimated to be 1.6% to 14% and is the most common injury of the lateral knee[4]
    • Among cyclists, the incidence is 15-24%[5]
    • Among military recruits, incidence ranges from 1% to 5.3%[6]
  • Note estimates of true incidence are challenging, many studies simply list knee injuries and not specifically ITBS


  • General
    • Atraumatic, overuse syndrome caused by friction or rubbing of the ITB over the lateral femoral epicondyle (LFE).
    • Commonly seen in running, cycling due to repeated flexion and extension of the knee
    • During eccentric contraction of the knee, Tensor Fasciae Latae & Gluteus Maximus cause deceleration, increasing tension in ITB
  • Impingement Zone[7]
    • During knee flexion, the ITB gets compressed against the LFE
    • Occurs at approximately 30° of knee flexion during foot-strike and early stance phase
    • After 30°, the ITB passes over and posterior to the LFE
  • Inflammation
    • With repetition, this leads to ITB inflammation as well as inflammation of the tissue/bursa between the ITB and LFE
    • Inflamed structures include lateral synovial recess, posterior fibers of ITB, periosteum of LFE[8]


Risk Factors

  • Sports
    • Running
    • Cycling
  • Occupations
    • Military recruits
  • Extrinsic Risk Factors
    • Downhill running
    • High running mileage
    • Too much time spent running in the same direction on the track
    • Uneven running style
    • Improper shoe/ bicycle fit
  • Intrinsic Risk Factors
    • Increased hip adduction[9]
    • Internal rotation of the knee
    • Femur external rotation
    • Prior IT band tightness
    • Muscle weakness of the Hip Abductors[10]
    • Younger age in men[11]

Differential Diagnosis

Differential Diagnosis Knee Pain

Clinical Features

  • History
    • Sharp/burning lateral knee pain
    • May see radiation of symptoms along the length of the ITB
    • Popping sensation sometimes noted over the lateral aspect of the knee with activity.
    • Pain is often experienced at a predictable distance/duration into a workout. Not present immediately upon beginning.
    • Pain usually subsides after activity cessation.
    • Pain worsened with downhill running, lengthening of stride, ascending/descending stairs, sitting for prolonged periods with knee flexed.[12]
  • Physical Exam
    • Classically, tenderness is appreciated at 2 cm above the lateral joint line with possible swelling
    • Crepitus may be palpated upon 30 degrees of knee flexion
    • Joint effusion is unlikely to be present and will suggest a distinct intra-articular cause
    • Evaluate for muscle strength differences and leg length discrepancy as these can contribute to ITBS
    • Imaging is not typically needed as this is a clinical diagnosis
  • Special Tests
    • Noble's Test: Pain elicited when the ITB is pressed against the lateral femoral condyle ranging from 0-90° flexion
    • Ober's Test: Patient lays in lateral decubitus position, affected leg up and allowed to adduct against gravity
    • Renne Test: Patient standing, hand placed on lateral femoral condyle, patient squats slowly to 60-90° of flexion


Coronal view of knee MRI consistent with IT Band syndrome. Seen is thickening of the IT band with signal changes, surrounding superficial edema



  • General
    • Typically normal
    • Not needed to confirm diagnosis, may be used to exclude other pathology
  • Potential findings
    • Ill-defined signal abnormality within the fatty soft tissues interposed between the ITB and bone
    • Soft tissues lateral to the lateral femoral condyle show low T1, high on T2 signal
    • Chronically, can see thickening of the IT band, increased T2 signal intensity


Lindenberg Classification

  • Classified by severity of symptoms[13]
  • Grade I: pain comes on after running, but does not restrict distance or speed
  • Grade II: pain comes on during running, but does not restrict distance or speed
  • Grade III: pain comes on during running and restricts distance or speed
  • Grade IV: pain is so severe that it prevents running





  • Indications
    • No relief after exhaustive conservative management.
  • Technique
    • All interventions aim to reduce compression of the ITB in this area. [12]
    • Resection of a portion of the ITB
    • ITB lengthening
    • Bursectomy

Rehab and Return to Play


  • Needs to be updated

Return to Play

  • After a 2-6 week rest period, may gradually return to activity.
  • Begin on level ground and gradually progress towards more distance, resistance, elevation.
  • Sprinting as opposed to longer, slower runs helps to avoid ITB friction.
  • Can attempt earlier return to activity with non-weight bearing activity such as swimming.
  • Prevent future injury with appropriate warm-up and stretching. [12]

Complications and Prognosis


  • Conservative therapy
    • Success rates reported as high as 94%[17]
  • Surgical
    • Hariri found all patients were able to return to pre-injury activity levels, reported less pain within 20 months of bursectomy[18]
    • Michels evaluated arthroscopic resection of lateral synovial recess and found excellent (80%) or good (17.1%) results[19]


  • Delayed return to sport
    • Recovery can be delayed if the athlete attempts to return to activity early despite persistent pain. [12]

See Also


  1. Colson JHC, Armour WJ. Sports injuries and their treatment. London: Stanley Paul & Co., Ltd; 1961.
  2. Renne J. The iliotibial band friction syndrome. The Journal of Bone and Joint Surgery 1975;57–A(8):1110–1
  3. Ellis, Richard, Wayne Hing, and Duncan Reid. "Iliotibial band friction syndrome—a systematic review." Manual therapy 12.3 (2007): 200-208.
  4. McNicol K, Taunton J, Clement D. Iliotibial tract friction syndrome in athletes. Canadian Journal of Applied Sport Science 1981; 6(2):76–80
  5. Farrell K, Reisinger K, Tillman M. Force and repetition in cycling: possible implications for iliotibial band friction syndrome. The Knee 2003;10:103–9
  6. Almeida S, Williams K, Shaffer R, Brodine S. Epidemiological patterns of musculoskeletal injuries and physical training. Medicine and Science in Sports and Exercise 1999;31(8):1176–82
  7. Orchard J, Fricker P, Abud A, Mason B. Biomechanics of iliotibial band friction syndrome in runners. American Journal of Sports Medicine 1996;24(3):375–9
  8. Kirk K, Kuklo T, Klemme W. Iliotibial band friction syndrome. Orthopedics 2000;23(11):1209–15
  9. Noehren B, Davis I, Hamill J. ASB Clinical biomechanics award winner 2006: prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech 2007; 22 (9): 951–6.
  10. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 2000; 10(3): 169–75.
  11. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36(2): 95–101.
  12. 12.0 12.1 12.2 12.3 Harrison N. et al. Iliotibial Band Friction Syndrome. In: Bracker M. et al. eds. The 5-Minute Sports Medicine Consult; 2011.
  13. Lindenberg G, Pinshaw R, Noakes TD. Iliotibial band friction syndrome in runners. Phys Sportsmed 1984; 12(5): 118–30.
  14. Pinshaw R, Atlas V, Noakes TD. The nature and response to therapy of 196 consecutive injuries seen at a runners’ clinic. S Afr Med J 1984; 65(8): 291–8
  15. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 2000; 10(3): 169–75
  16. Gunter P, Schwellnus MP. Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. Br J Sports Med 2004; 38(3): 269–72.
  17. McNicol K, Taunton J, Clement D. Iliotibial tract friction syndrome in athletes. Canadian Journal of Applied Sport Science 1981; 6(2):76–80
  18. Hariri S, Savidge ET, Reinold MM, et al. Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy: indications, technique, and clinical outcomes. Am J Sports Med 2009; 37(7): 1417–24.
  19. Michels F, Jambou S, Allard M, et al. An arthroscopic technique to treat the iliotibial band syndrome. Knee Surg Sports Traumatol Arthrosc 2009; 17(3): 233–6
Created by:
John Kiel on 4 July 2019 04:57:19
Last edited:
15 September 2021 12:42:37