Physical Medicine and Rehabilitation for Iliotibial Band Syndrome 

  • Author: John M Martinez, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Jan 18, 2012
 

Background

Iliotibial band syndrome (ITBS) is the result of inflammation and irritation of the distal portion of the iliotibial tendon as it rubs against the lateral femoral condyle, or less commonly, the greater tuberosity. This overuse injury occurs with repetitive flexion and extension of the knee. Inflammation and irritation of the iliotibial band (ITB) also may occur because of a lack of flexibility of the ITB, which can result in an increase in tension on the ITB during the stance phase of running. See the image below.

In this 27-year-old female marathon runner with anIn this 27-year-old female marathon runner with anterolateral pain superior to the joint line, a coronal fast spin-echo T2-weighted magnetic resonance imaging scan with fat suppression demonstrates edema between the iliotibial band and the lateral femoral condyle (arrow). The edema's location is consistent with a clinical diagnosis of iliotibial band syndrome.

Other causes or factors that are believed to predispose an athlete to ITBS include excessive internal tibial rotation, genu varum, and increased pronation of the foot.

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Pathophysiology

The iliotibial band (ITB) is a dense fibrous band of tissue that originates from the anterior superior iliac spine region and extends down the lateral portion of the thigh to the knee. The ITB has insertions on the lateral tibial condyle (ie, the Gerdy tubercle) and the distal portion of the femur. When the knee is extended, the ITB is anterior to the lateral femoral condyle. When the knee is flexed more than 30º, the ITB is posterior to the lateral femoral condyle.[1] See the images below.

Iliotibial band at the lateral femoral condyle, wiIliotibial band at the lateral femoral condyle, with the posterior fibers denoted. Iliotibial band noted prominently along the lateraIliotibial band noted prominently along the lateral thigh. Lateral hip stabilizers. Lateral hip stabilizers.
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Epidemiology

Frequency

United States

Iliotibial band syndrome (ITBS) is most common in athletes who participate in long-distance running. Studies have indicated a 4.3-7.5% occurrence rate for ITBS in long-distance runners. ITBS is less common in shorter-distance or sprint-distance runners. The higher rate in long-distance runners is primarily because of the increased stance phase during longer-distance running. ITBS also has been reported in military recruits, cyclists, and tennis players. The frequency of ITBS is also increased in adolescents undergoing the rapid growth phase.[2, 3, 4, 5]

Mortality/Morbidity

No mortality has been associated with iliotibial band syndrome.

Race

No known association exists between race and iliotibial band syndrome.

Sex

Iliotibial band syndrome has been reported in men and women equally; however, women may be more susceptible to developing the syndrome because of anatomical differences of the thigh and knee, such as genu varum and increased internal tibial rotation. These anatomical differences result in weakness of the quadriceps muscle and an increased varus angle of the femur in relation to the knee.

Age

Iliotibial band syndrome usually is seen in individuals aged 15-50 years, an age range that generally includes active athletes.

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Contributor Information and Disclosures
Author

John M Martinez, MD  Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center

John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Honsik, MD  Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente

Disclosure: Nothing to disclose.

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD  Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center

Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association

Disclosure: Nothing to disclose.

References

  1. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R. Jun 2011;3(6):550-61. [Medline].

  2. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. May 2006;16(3):261-8. [Medline].

  3. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-9. [Medline].

  4. Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). Oct 2008;23(8):1018-25. [Medline].

  5. Grau S, Maiwald C, Krauss I, Axmann D, Horstmann T. The influence of matching populations on kinematic and kinetic variables in runners with iliotibial band syndrome. Res Q Exerc Sport. Dec 2008;79(4):450-7. [Medline].

  6. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. Apr 15 2005;71(8):1545-50. [Medline]. [Full Text].

  7. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. Dec 2011;19(12):728-36. [Medline].

  8. Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it?. Skeletal Radiol. Dec 2011;40(12):1553-6. [Medline].

  9. Grau S, Krauss I, Maiwald C, et al. Hip abductor weakness is not the cause for iliotibial band syndrome. Int J Sports Med. Jul 2008;29(7):579-83. [Medline].

  10. Ilizaliturri VM Jr, Martinez-Escalante FA, Chaidez PA, et al. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. May 2006;22(5):505-10. [Medline].

  11. Hariri S, Savidge ET, Reinold MM, Zachazewski J, Gill TJ. Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy: indications, technique, and clinical outcomes. Am J Sports Med. Mar 13 2009;[Medline].

  12. Michels F, Jambou S, Allard M, Bousquet V, Colombet P, de Lavigne C. An arthroscopic technique to treat the iliotibial band syndrome. Knee Surg Sports Traumatol Arthrosc. Mar 2009;17(3):233-6. [Medline].

  13. Adams WB. Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears. Curr Sports Med Rep. Oct 2004;3(5):256-60. [Medline].

  14. Biundo JJ Jr, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. Mar 2001;13(2):146-9. [Medline].

  15. Brosseau L, Casimiro L, Milne S. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002;CD003528. [Medline].

  16. Faraj AA, Moulton A, Sirivastava VM. Snapping iliotibial band. Report of ten cases and review of the literature. Acta Orthop Belg. Feb 2001;67(1):19-23. [Medline].

  17. Fredericson M, Cookingham CL, Chaudhari AM. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. Jul 2000;10(3):169-75. [Medline].

  18. Garrick JG, Webb DR. Sports Injuries. Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1999.

  19. Jones RL. The injured or painful knee and its evaluation. In: Clinics in Family Medicine. 1999 Dec:209.

  20. Kendal FP, et al. Muscles: Function and Testing. 4th ed. Baltimore, Md: Williams & Wilkins; 1993.

  21. Noble CA. The treatment of iliotibial band friction syndrome. Br J Sports Med. Jun 1979;13(2):51-4. [Medline]. [Full Text].

  22. Sutker AN, Barber FA, Jackson DW, Pagliano JW. Iliotibial band syndrome in distance runners. Sports Med. Nov-Dec 1985;2(6):447-51. [Medline].

 
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In this 27-year-old female marathon runner with anterolateral pain superior to the joint line, a coronal fast spin-echo T2-weighted magnetic resonance imaging scan with fat suppression demonstrates edema between the iliotibial band and the lateral femoral condyle (arrow). The edema's location is consistent with a clinical diagnosis of iliotibial band syndrome.
Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
Iliotibial band noted prominently along the lateral thigh.
Lateral hip stabilizers.
The Thomas test can be used to evaluate restriction in the iliotibial band and hip flexors.
The Ober test.
This illustration demonstrates active stretching of the iliotibial band (ITB). The athlete stands a comfortable distance from a wall and, with the contralateral knee extended, leans the proximal shoulder against the wall to stretch the ipsilateral ITB.
This illustration demonstrates iliotibial band syndrome stretching performed in a side-lying position.
 
 
 
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