Physical Medicine and Rehabilitation for Iliotibial Band Syndrome

Updated: Apr 04, 2018
  • Author: John M Martinez, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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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 an 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.

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.



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



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]


No mortality has been associated with iliotibial band syndrome. A study by Hafer et al indicated that coordination variability in runners is not affected by ITBS-associated pain. The investigators found that at the start and end of a run, coordination variability did not differ between uninjured runners and runners with ITBS. [6]


No known association exists between race and iliotibial band syndrome.


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. [7, 8]


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