Iliotibial Band Friction Syndrome

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The iliotibial band is a thick fibrous band which runs along the outer sideofthe thigh, and attaches to the outer side of the tibia just below the knee.

As the knee bends and straightens, the iliotibial band (ITB) shifts backwards and forwards, passing over a bony prominence on the outer side of the femur (the lateral femoral condyle). The shift occurs when the knee is bent to approximately 30degrees.

    

The repetitive bending and straightening of the knee in running can lead to irritation of the iliotibial band as it passes back and forth over the lateral femoral condyle. This may lead to inflammation and pain in the surrounding tissues and bursa(cushion of fluid).

Symptoms

• Gradual onset of pain, tightness or burning on outer aspect of knee which develops during a run
• Symptoms usually resolve with rest
• Tenderness on pressure on outer aspect of thigh, immediately above knee
• Sometimes visible swelling over the tender area
• Creaking or snapping or popping sound when the knee is bending and straightening
  

Causative factors

• Tight iliotibial band
• Running on pitched surfaces (e.g. running on roads with steep camber) or on a track, always in the same direction
• Recent increase in running distance
• Downhill running
• Repetitive knee bending and straightening in activities such as cycling, descending stairs for long distances (e.g. Maclehose trailwalking)
• Skiing
• Unequal leg lengths
• Overpronation of the feet

Treatment

Acute stage

• Rest from running until symptoms have resolved
• Anti-inflammatory medication (oral NSAIDs)
• Rest from exercise such as cycling, skiing, stairs
• Ultrasound, & interferential treatment to reduce inflammation

Deep tissue massage to iliotibial band