Illiotibial Band Friction Syndrome

The Illiotibial band (ITB) runs along the lateral aspect of the thigh, formed by the tensor fascia lata and the gluteus maximus. It originates at the iliac crest and inserts into the lateral tibial condyle, crossing the hip and knee joints.

Illiotibial band friction syndrome (ITBFS) describes the phenomenon common to runners whereby the deep part of the ITB rubs against the lateral femoral epicondyle during knee movement. The ‘friction’ of the ITB against the bony femoral prominence causes pain that classically occurs during foot strike as this is the angle at which contact between the two structures occurs. It is the second most common injury sustained by runners, accounting for approximately 8% of presentations to sports medicine clinics and is more commonly seen in males.

The classic presentation of ITBFS is that of generalised ache over the lateral aspect of the knee, which is exacerbated by running, especially on downhill slopes. It commonly begins after a recent change in training intensity, with the onset of the pain typically occurring after a set duration or distance into a run.

On examination, the individual often has marked tenderness over the lateral epicondyle of the femur, found just above the lateral joint line of the knee. However, proximal discomfort may also be a feature. This discomfort is particularly obvious on examination after passive repeated flexion and extension of the knee at an angle of around 30º when the patient may describe a burning sensation.

Treatment relies on reducing the stimulus, which may involve adjusting frequency, intensity and type of training. Early management with ice and NSAIDs reduces local inflammation and a corticosteroid injection into the area between the ITB and the lateral femoral epicondyle may improve acute pain.

Biomechanical factors must be considered and corrected as many abnormalities can predispose to ITBFS. A genu varus deformity increases the tension of the ITB across the lateral femoral epicondyle and can be targeted during rehabilitation. Tightness of the ITB will also increase the tension at the knee, predisposing to ITBFS. Stretching of the ITB forms an integral part of the treatment, as well as self-massage, which can be performed on a foam roll.

There are several surgical procedures that may be used in unresponsive cases of ITBFS, aiming to excise the small area of the ITB that is abrading the lateral femoral epicondyle or removing the bony prominence itself. The surgical outcomes are usually favourable and commonly enable return to sport.