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Iliotibial Band Syndrome (ITBS) - Causes, Manifestations, and Treatment

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Iliotibial band syndrome is a health problem of the knee, most commonly seen in athletes involved in running.

Medically reviewed by

Dr. Anuj Nigam

Published At September 21, 2022
Reviewed AtApril 18, 2024

Introduction:

Iliotibial band syndrome, more commonly known as IT band syndrome, is a health problem of the knee, most commonly seen in athletes involved in running or people newly adapting to exercise schedules. It is a fibrous tissue that runs along the lateral side of the thigh and extends from the hip bones to the top of the tibia. The band moves over the outer lower edge of the femur when bending or extending the knee joint. Repetitive bending and stretching of the knee cause the band to irritate nearby tissues, causing pain.

What Are the Causes Behind ITBS?

The exact cause of iliotibial band syndrome is obscure, research is still ongoing, and the actual reason is debatable. The pain is believed to be a result of friction. The iliotibial band rubs directly against the lower outer edge of the femur, causing inflammation of the bone itself and the surrounding tendons and causing the formation of tiny, fluid-filled sacs in the area. The pain may also result from the band pressing directly against the underlying tissue causing compression. Although the exact cause is unclear, repetitive bending and extending of the knee are in some way responsible for the condition.

Who Are Prone to Developing ITBS?

ITBS is most typically a disease seen in distance runners. Still, it may occur in other sports, like cycling, skiing, rowing, or soccer, which involves continuous extension and bending of the knee joint.

For running athletes, iliotibial band syndrome may develop due to the following activities;

  • Running on uneven or downhill terrain.

  • Running in worn-out shoes.

  • Run many miles per day.

  • Have a bow-legged deformity.

  • Running in cold weather.

How Commonly Does Iliotibial Band Syndrome Occur?

Iliotibial band syndrome affects U.S. mariners during training, with around 20 percent of soldiers developing the condition. Frequent and long-distance runners who fail to take adequate precautions or have some deformities are also equally predisposed. Iliotibial band syndrome constitutes about 12 percent of running-related injuries. Females are more inclined to develop the condition, and 25 percent of adults who develop knee pain are also diagnosed with the disease.

What Are the Signs and Symptoms of Patients Suffering From the Condition?

The common signs and symptoms of iliotibial band syndrome are as follows:

  • Pain Location: Iliotibial band syndrome causes pain on the outer or lateral side of the knee and may affect one or both. The pain may be an aching or burning type that may radiate through the thigh to the hip.

  • Pain Worsens With Activity: The pain may be evident only during exercise or running. Initially, the pain feels worse right after a strike on the foot. In the later stages of the syndrome, the onset of the pain occurs toward the end of the workout regimen. As the condition aggravates, the pain might start earlier and continue for prolonged periods after the daily workout. Mundane activities such as going up and down the stairs may also trigger pain in advanced cases.

  • Tenderness: There may be tenderness on the outer side of the thigh or knee.

  • Clicking or Popping Sensation: There may be a clicking or popping sensation in the knee when bending or straightening the leg. However, this symptom is not always present.

  • Stiffness: The knee may be stiff after a long period of rest.

How Is ITBS Diagnosed?

The diagnostic procedure of ITBS is described below:

  • Patient History: The patient's case history is recorded, and all their signs and symptoms are noted.

  • Physical Examination: The healthcare provider physically examines the knee joint. The joint evaluation includes testing the range of motion, strength, and sore areas of the knee joint and its surroundings. Other probable causes of knee pain, such as osteoarthritis (joint inflammation) or meniscal tears (knee injuries), need to be ruled out.

  • Imaging Tests: However, in confusing cases, imaging tests, like X-rays or MRI (magnetic resonance imaging) scans, may be necessary. These tests are prescribed to rule out the cause of knee pain and to assess any structural abnormalities.

What Are the Lines of Treatment for ITBS?

Treatment modalities for ITBS may include both non-surgical and surgical approaches. However, the latter is rarely recommended.

  • Rest: The patient is asked to refrain from exercising until the pain subsides and the condition has healed completely. The amount of rest and activity during this period should be instructed by the physician.

  • Pain Medications: Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed to reduce and manage pain. In severe cases, opioids may also be prescribed for a limited period.

  • Physiotherapy: A physical or occupational therapist might prescribe foam massages and strengthening exercises to minimize symptoms and maintain the functionality of the affected area.

  • Posture Training: Posture correction is also necessary in several cases to prevent deterioration of the iliotibial band and help recover and prevent future relapse of the disease.

  • Steroid Injections: Corticosteroid injections may help reduce inflammation in the affected area. However, prolonged use should be avoided to prevent complications.

  • Surgery: Surgery is rare and is recommended only if medications and physical therapy fail to eliminate the disease.

ITBS

Once pain-free, patients can slowly resume their regular activities with physician consultation and advice.

What Are the Preventive Measures for ITBS?

Iliotibial band syndrome is preventable in several cases. In order to help prevent flare-ups, the following precautionary measures may be opted for;

  • Running on even surfaces and refrain from running downhill.

  • Replacing the running shoes regularly.

  • Relax the training schedule.

  • The patient must ensure to run in both directions alternately on a track.

  • Have regular stance examinations for running and other sporting activities under the guidance of relevant experts.

  • Stretching exercises for the outer thigh and hamstrings should be done regularly, particularly before arduous training.

  • If the patient begins exercise or starts a more strenuous regimen, a slow start and gradual activity increase are recommended.

  • A trainer or a medical expert should be consulted regularly for additional advice.

What Are the Possible Complications of ITBS?

Iliotibial band syndrome can give rise to patellofemoral pain syndrome. Pain around and under the kneecap or patella is felt in this condition. In addition, it may also cause knee and hip pain. The physician should be made aware of any additional symptoms.

Conclusion:

ITBS is most typically a disease seen in distance runners. Still, it may occur in other sports, like cycling, skiing, rowing, or soccer, which involves continuous extension and bending of the knee joint. The patient is asked to refrain from exercising until the pain subsides and the condition heals completely. The amount of rest and activity during this period should be instructed by the physician. If left untreated, iliotibial band syndrome can give rise to patellofemoral pain syndrome.

Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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iliotibial band tightness
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