Iliotibial Band Syndrome

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What is the anatomy involved in iliotibial band syndrome?  The iliotibial band (IT band) is a long flat tendon on the outside (lateral side) of the hip, thigh, and knee. The tensor fascia lata muscle and part of the gluteus maximus muscle attach to the tendon at the top (proximally). At the bottom (inferior) end, the tendon attaches to the top part of the shin bone (tibia) just below the knee joint to a bony prominence called Gerdy's tubercle.

The iliotibial band slides over the bump (lateral epicondyle) on the outside (lateral side) of the knee when the knee is bent. This is where iliotibial band syndrome develops. When the knee is straight, the iliotibial band is in front of the bump. When the knee is bent, the iliotibial band is behind the bump. It slides over the bump when the knee is bent about 30 degrees.

There is a small fluid filled sack (bursa) between the iliotibial band and the underlying bump (lateral femoral epicondyle). There are bursa in many places in the body. They are flat fluid filled sacks that allow tendons to slide over bones with minimal friction.

What is iliotibial band syndrome?

Iliotibial band syndrome, also called IT band friction syndrome, is an overuse injury caused by excessive friction between the iliotibial band and lateral femoral epicondyle. The bursa may be inflamed as part of the syndrome.

Symptoms

What may predispose me to getting iliotibial band syndrome?

It is most often seen in runners, but it is also seen in cyclist and other athletes. There are several factors that may predispose you to getting iliotibial band syndrome:
-downhill running or running on banked surfaces
-bowed knees (genu varum)
-foot pronation
-increases in training without conditioning
-tight iliotibial bands

How is iliotibial band syndrome diagnosed?

Iliotibial band syndrome often has the following characteristics:
-pain over the outside (lateral side) of the knee
-worsened by running, especially on hills and banked surfaces
-recent long runs or increases in training
-worsened by stairs

On physical exam, a physician may find the following:
-tenderness over the lateral epicondyle of the femur
- pain reproduced at 30 degrees of knee flexion while placing pressure on the lateral epicondyle and bringing the knee from flexion into extension
-bowed knees (genu varum)
-Iliotibial band tightness
-lack of findings on physical exam that would point towards another cause of the pain

Imaging is often not needed to make the diagnosis. However, if there is concern for other problems, x-rays and/or MRI may be ordered. X-rays would rule out underlying bone problems, such as arthritis and would also show the degree of "bowing" of the knees. MRI would rule out other potential causes of pain in this location, such as a lateral meniscus tear. An MRI may show inflammation in the bursa and lateral epicondyle with severe cases.

Prevention

How can iliotibial band syndrome be prevented in athletes?

While ilitobial band syndrome may develop in running athletes despite attempts at prevention, certain measures may help to reduce the risk of developing iliotibial band syndrome. These include:
-regular stretching of the iliotibial band
-appropriate footwear and orthotics, particularly to correct foot pronation
-gradually increase training (avoid abrupt increases)
-avoid running downhill and on banked surfaces

Treatment

What does nonsurgical treatment entail?

Nonsurgical treatment is almost always successful. This may be done independently or with the assistance of a physical therapist or athletic trainer. Treatment can be found by clicking the following link on iliotibial band syndrome.

Be sure to take a look at the following SportsMD iliotibial band stetching video.
Iliotibial Band Stretch - 2 Stretches.

If you suspect that you have iliotibial band syndrome, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor in your area, please visit our Find a Sports Medicine Doctor Near You section.

This article has been written by Asheesh Bedi, MD, a fellowship-trained orthopaedic surgeon specializing in Sports Medicine. He is currently the Assistant Professor for Sports Medicine and Shoulder Surgery, at the University of Michigan Health System. For more information on sports related injuries please visit www.sportsmd.com.

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