What is Iliotibial Band Syndrome (ITBS)?

Iliotibial band syndrome is an irritation or swelling of a tendon called the iliotibial band caused by the sliding of your hip and knee bones against this tendon. Your tendon runs down the outside of your leg, from the top of your pelvic bone to the bottom of your knee. It slides against your bones when it is tight enough. There are lots of reasons that your iliotibial band might be tight.

Tendons are flexible, rubber-like fibrous tissues that attach muscles to bones. When you squeeze a muscle, your tendon pulls on the bone, moving it.

What are types of iliotibial band syndrome?

One can have ITBS in one leg, while on the other hand, you can get it in both legs. When one gets ITBS in both legs, this is referred to as bilateral iliotibial band syndrome.

Who gets iliotibial band syndrome (ITBS)?

You're more likely to get iliotibial band syndrome if you are young and exercise regularly. Some of the most at-risk athletes are:

Basketball players.
Cyclists
Hockey players.
Runners.
Skiers.
Soccer players.

Even if you are not one of these athletes, a few characteristics make you more prone than usual to getting iliotibial band syndrome. Causes are:

Bow legs
Having a leg longer than the other.
Knee arthritis.
You twist your ankle, leg or foot when you run.
You have weak muscles in your butt, hips, and abdomen.

How prevalent is iliotibial band syndrome?

According to experts, iliotibial band syndrome commonly occurs in U.S. Marines who train. Over 20% of those become victims. Frequent runners, especially distance runners, are prone to it. Iliotibial band syndrome contributes to approximately 12% of running injuries. More females develop iliotibial band syndrome than males.

Iliotibial band syndrome may be the cause of the aching in the knees that 25 percent of people are destined to experience.

What causes iliotibial band syndrome?

When pulled too taut, your iliotibial band becomes inflamed and swollen and rubs against a bone. Possible causes of an over-tight iliotibial band include:

An extremely tight iliotibial band may result from the following factors:

Overpronation: An excessive outward rotation of the foot. Doing so allows you to stretch and bring the iliotibial band closer to your bones.
Hip abductor weakness: Lateral excursion is when the hip turns away from the body. A weakened ability to rotate the hip may cause the iliotibial band to become tight.
Internal tibial torsion: Another term for your shinbone is your tibia. An internal tibial torsion refers to your tibia being twisted inward to your body. This will pull your iliotibial band closer towards your bones.
Arthritis in the medial compartment causing genu varum: Arthritis in your knee joint is known as medial compartment arthritis. Genu varum causes your knees to diverge when your feet touch your ankles, stretching and tightening your iliotibial band.
Previous tightness in your iliotibial band: You may have been just born with an iliotibial band, more tight.

You iliotibial band may be rubbing against your bones due to the following:

Cooling down too fast after exercise.
Lack of sleep.
Insufficient warm-up and stretching before exercising.
Overtraining when exercising.
Running on a slant or curved slope.
Running downhill.
Slow warm-up before exercising.
Treadmill runners: dead, worn-out shoes

What are the signs of iliotibial band syndrome (ITBS)?

A tight, uncomfortable iliotibial band can cause several signs:

Hip pain: Your iliotibial band often rubs your greater trochanteric inside your hip. This greater trochanteric is that part of your bone that expands close to the top of your femur. The force in that friction leads to inflammation in your tendon and pain within your hip. You might also hear a snapping sound.
Clicking sensations: You might feel a pop, snap or click on the outside of your knee.
Knee pain: Your lateral epicondyle is the bony bump at the bottom of your femur where it flares out on the outer side of your knee.Your tight iliotibial band continually scrapes against it with every knee bend and straightening action. The motion produces irritation in your tendon and pain inside your knee.
Lateral redness and warmth: The outside of your knee may look splotchy and warm.

Initially, the pain will start after you exercise. As the syndrome worsens, you'll experience it throughout the entire time that you exercise and even when you are resting.

What does iliotibial band syndrome feel like?

The person diagnosed with the condition says the pain feels aching and burning at first. The sharper it becomes the more the person exercises their leg and when the syndrome worsens. Describe to your health professional not only where the pain coming from iliotibial band syndrome is, but also what it feels like.

What are the treatments for iliotibial band syndrome?

Your healthcare provider may treat you for iliotibial band syndrome after he has discussed your history of exercise and symptoms and performed a physical examination. Your provider should look for the following signs of ITBS:

A grating sensation or noise as your hips or knees move.
One or both of your hips may hurt over the greater trochanter.
Pain around the lateral epicondyle of one or both your knees.
Pain that you feel more the more that you exercise.
Pain that worsens as you go downhill.

What are the tests for diagnosing iliotibial band syndrome (ITBS)?

Your physician may perform a test known as the Noble and Ober test. Several steps include:

Your doctor will palpate your lateral epicondyle on the outside of your knee to help figure out if the source of your pain in iliotibial band syndrome is coming from that area.
Moving your hip away from your body with your knee in a stabilizing position can be painful, and you will most likely be unable to move your hip very far.
Moving your knee through different angles to determine if that recreates your symptoms.

Diagnostic imaging tests, which may involve:

MRI: If the doctor is still unsatisfied with the suspected diagnosis, they may demand an MRI. MRI will be useful for them in the process of elimination and will rule out other injuries such as meniscus tear or LCL injury.
Ultrasound: An ultrasound can prove that you have iliotibial band syndrome as it could point out exactly how your iliotibial band moves while flexing or extending your hip or knee.

What are some possible questions a healthcare provider would ask to diagnose iliotibial band syndrome?

Your health care professional will be interested in understanding precisely what you're experiencing so you're best prepared. Questions they may ask include:

What are your symptoms?
Where is the pain?
What does the pain feel like?
How long have you been having these symptoms?
What medications do you take?
What is your level of pain?
Do you engage in sports?
Is the pain worse when you exercise for a more extended period?

How is iliotibial band syndrome treated?

Some treatments for iliotibial band syndrome may be done at home. Others require a health care provider. Some common treatments include:

Rest: Some physicians recommend that you minimize stress on your injured leg until your pain is gone and your iliotibial band syndrome has resolved. Discuss with your provider how much rest and activity you should have.
Pain medications: Examples of NSAIDs include Ibuprofen (Advil®, Motrin®) and Naproxen (Aleve®). Talk to your healthcare practitioner about the appropriate doses.
Manual treatment: A physiotherapist may teach you how to roll out your body with a foam roller.
Physiotherapy: A physiotherapist can educate you on stretches, strengthening exercises, and other therapies to help relieve hip and knee pain. These may help lengthen your iliotibial band and reduce its tension. A physiotherapist may also teach you how to warm up properly before exercise and cool down afterwards.
Posture training: How you hold yourself when going about your activities, exercising or otherwise, might contribute to the onset of iliotibial band syndrome.
Steroid injections: Using corticosteroids may reduce the inflammation in your iliotibial band.
Surgery: Surgery on iliotibial band syndrome is relatively not common. Your health care provider will advise you to undergo surgery if medication and physiotherapy do not work.

Does iliotibial band syndrome go away?

Your iliotibial band syndrome will likely improve after such treatments as rest, physical therapy, and medications. The pain may tend to increase if you do not seek medical care. Talk to your healthcare provider about your choices.

What can I do to lower my chances of developing iliotibial band syndrome (ITBS)?

Prevention of ITBS might prove difficult if you're an athlete whose sport involves skiing, cycling or running a long distance. But you could try changing some of the ways you do those activities to minimize the risk factors of ITBS. Examples include:

Avoid running up or down a hill or any slanted surface.
Be sure to have the proper technique regardless of what you are doing.
Gradually alter the intensity of your shift training. Instead of going directly from a real slow pace to full gallop or vice versa, you should gradually accelerate while on a bike.
Gradually warm up and gradually cool down.
Wear supportive shoes.

How long is the recovery period for iliotibial band syndrome (ITBS)?

With treatment, especially nonsurgical treatment, about 50 to 90% of patients with ITBS improve within roughly four to eight weeks. Other research shows that it is between two to six weeks.

Does iliotibial band syndrome worsen?

Iliotibial band syndrome can worsen if left untreated. Consult your healthcare provider to discuss with him or her physical therapy, medications and more.

What are the complications of this condition?

PFPS may sometimes be caused by iliotibial band syndrome. You may feel pain on the sides, beneath your kneecap (patella), and in the knee and hip. Discuss this with your doctor if symptoms persist or worsen. There are treatments for PFPS.

Living With

How long will it be before I can return to my regular activities?

Once you are pain-free, your healthcare provider may allow you to gradually return to your daily activities.
Plan with your healthcare provider.
Discuss with your physician the activities you may engage in and the best times to do them safely.