Iliotibial Band (IT Band) Syndrome

By Amy Miller Bohn, M.D.

University of Michigan

Iliotibial band syndrome is a common knee injury that usually presents as pain on the outer side of the knee. The iliotibial band is a layer of connective tissue beginning at a muscle near the outer side of the hip, and travels down the outer side of the thigh, crossing the outer side of the knee and attaching to the outer side of the upper shin bone (tibia).

Iliotibial band syndrome is caused by excessive friction of the distal portion of the iliotibial band as it slides over the outside portion of the knee during repetitive bending, resulting in inflammation in this area. Some studies have identified potential risk factors for the development of iliotibial band syndrome including preexisting iliotibial band tightness; high weekly mileage; time spent walking or running on a track; interval training; and muscular weakness of the knee, hip, or pelvis.

Symptoms

The primary initial complaint in individuals with iliotibial band syndrome is diffuse pain over the outside of the knee. These people frequently are unable to indicate one specific area of tenderness, but they tend to use the palm of the hand to indicate pain over the entire outside aspect of the knee.

With time and continued activity, the initial discomfort progresses into a more painful, sharp, and localized irritation. Typically, the pain begins after the completion of a run or several minutes into a run or another long-distance activity. However, as the iliotibial band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session and can even occur when the person is at rest. Those injured often note that the pain is aggravated while running down hills, lengthening their stride, or sitting for long periods of time with the knee in a bent position.

Diagnosis
In order to diagnose iliotibial band syndrome, your health care provider will examine your knee and find tenderness where the band passes over the bump on the outer side of your knee. They may also put your leg in a certain position to isolate the iliotibial band and to determine if there is excessive tightness of the iliotibial band.

Treatment

Treatment of iliotibial band syndrome begins with selecting proper footwear, icing the area of pain, and beginning a stretching routine. Limiting excessive training, resting for a period of time, and incorporating low-impact cross-training activities may also help. Anti-inflammatory medications may be prescribed by your doctor to help decrease the inflammatory response around the area of irritation. If these treatments do not solve the problem, working with a physical therapist to develop a more focused stretching and strengthening routine may help. Cortisone injection into the area of inflammation may also be attempted, usually after these other treatments fail. If all else fails, surgery is an option, but only in very rare circumstances.

Recovery

The length of recovery depends on many factors such as your age, health, and history of previous injury. Recovery time also depends on the severity of the injury. A mild injury may recover within a few weeks, whereas a severe injury may take six weeks or longer to recover. If you continue doing activities that cause pain, your symptoms may return and it will take longer to recover.

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when your injured knee can be fully straightened and bent without pain, your knee and leg have regained normal strength compared to the uninjured knee and leg, and you are able to walk or jog straight ahead without limping.

Prevention

Iliotibial band syndrome is best prevented by warming up properly and doing stretching exercises before sports or other physical activity.

Amy Miller Bohn, M.D. University of Michigan