What is iliotibial band syndrome?

Iliotibial band syndrome (IT band syndrome or ITBS) occurs when the iliotibial band (IT band), the ligament that runs along the outside of the leg from hip down to the shin, becomes tight, painful and inflamed. The IT band helps stabilize and move the knee joint.

IT band syndrome is very common in long distance runners. If the condition is severe, the runner may not be able to run for weeks or months.

Causes of iliotibial band syndrome (ITBS)

The most common cause of IT band syndrome is overuse. Long distance runners may develop this condition when they increase their mileage in training. If overuse is the cause of your IT band syndrome, it is important to rest the injury right away to avoid making the condition worse. Other causes of IT band syndrome are:

  • Tight muscles or lack of flexibility — if the muscles in the hips and on the side of the leg are tight or inflexible, this could cause IT band issues since all the tissues are connected from your hip to your foot.
  • Weak muscles — if the muscles in the hip are weak, it can cause a person’s running form to break down as the mileage increases.
  • Wearing incorrect or old shoes — old, worn out shoes can cause IT band syndrome; it is important to rotate shoes regularly to avoid this factor causing the condition.
  • Poor running form — some patients develop IT band syndrome from incorrect running form. In many cases, a professional coach can help you change your form to alleviate the pain from IT band syndrome.

Risk factors for Iliotibial band syndrome (ITBS)

  • Skipping warm-up or stretching — muscles that are not warmed up prior to exercise are more likely to get tight and cause IT band syndrome.
  • Athletes — although runners and cyclists are most at risk, any athlete who competes in a sport that requires repetitive knee movement can be at risk, including basketball players, downhill skiers, soccer players, weightlifters and wrestlers.
  • Leg length — people with bow legs or legs of different lengths could be predisposed to developing IT band pain because of misaligned joints or biomechanical problems.
  • Age and gender — men under 34 are more likely to develop IT band syndrome.

Symptoms of iliotibial band syndrome (ITBS)

Pain on the outside of the knee during exercise (especially running and jumping) is the most common symptom of IT band syndrome. The pain is caused by inflammation to the band as it crosses back and forth over the side of the knee joint. The pain may begin with mild pricks that can quickly move to more severe pain every time the heel hits the ground. Some patients also experience the following symptoms:

  • Popping or snapping in the knee
  • Swelling on the outer side of the knee
  • Pain that radiates from the hip all the way down to the ankle

Diagnosis of iliotibial band syndrome (ITBS)

IT band syndrome is diagnosed in a physical exam with your orthopedic physician. In many cases, the physician can diagnose the patient with IT band issues purely based on symptoms and location of pain.

The physician will get a full medical history, examine the legs and knees for any tightness, leg-length discrepancy or swelling. Outer knee pain can be caused by a variety of conditions, so your physician may order an x-ray and MRI to locate the exact location of the injury. An MRI will be able to see any inflammation and locate tears that could be other knee injuries such as a meniscus tear.

Treatments for iliotibial band syndrome (ITBS)

Initial treatment for IT band syndrome is ice, compression and rest in combination with anti-inflammatory medication. Mild cases of this condition can be healed by home therapy, massage, using a foam roller on the impacted area and staying off the leg.

Physical therapy is a common treatment for ITBS. Your physical therapist will develop a rehabilitation program that will strengthen the weak areas of the legs, knee, core and back. He or she will also advise the athlete on ways you can modify your training to see faster results with therapy. Runners or cyclists will be encouraged to reduce training to allow the IT band to heal.

A corticosteroid injection at the site of the inflammation and pain may provide short-term relief from ITBS pain.

Recovery from iliotibial band syndrome (ITBS)

Recovery from IT band injury can be as little as a few days if it is caught early and corrections are put in place right away. If the condition worsens, IT band injuries can cause pain for many months.

It is important to correct the cause of the IT band issue to ensure it does not return. Work closely with your physician or physical therapist to develop a customized plan for you.

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