Ilio-tibial band (ITB) friction syndrome


Expert reviewer, Elisabeth Morgans, Bupa Physiotherapist
Next review due April 2021

Iliotibial band syndrome (ITB syndrome) is the most common cause of pain on the outside of the knee in runners and other sports people.

Your iliotibial band (IT band) is a thickened band of tissue that runs all the way down the length of your thigh. It works with your knee ligaments to help stabilise your knee joint. ITB syndrome happens when your IT band rubs repeatedly against the lower end of your thigh bone as it joins your knee. This friction causes inflammation and pain.

ITB syndrome is also known as iliotibial band friction syndrome.

An image showing the different parts of the knee

Symptoms of iliotibial band syndrome

Iliotibial band (ITB) syndrome causes a sharp pain or ache on the outside of your knee, which may spread up or down your leg. It’s usually associated with running or cycling. Some people feel a pain in their hip too. The pain may be worse when you’re running downhill, or if you run or cycle for longer than normal. You’ll probably find that the pain starts at a similar point in your run, and disappears when you stop.

Usually, you’ll only experience pain when you do activities such as running or cycling. But if the problem gets worse, it can start to affect you even when you’re just walking or sitting with your knee bent./p>

The outside of your knee may be tender to the touch and you may have some swelling.

Causes of iliotibial band syndrome

You usually get iliotibial band (ITB) syndrome if you run or cycle, and occasionally if you do other sports such as tennis or football. You’re unlikely to get ITB syndrome if you don’t take part in these types of sport. ITB syndrome is an overuse injury – it tends to get worse with repeated movement. You’re more likely to get it the more you do over the course of a week.

There are certain things to do with how you run or exercise that can put you at greater risk of developing ITB syndrome. These include if you:

  • run for long distances or for a long time
  • are new to running or you suddenly increase how far or how often you run
  • wear worn-out running shoes
  • run on slippery or uneven ground
  • have sudden changes to the surface you run on, for example soft to hard or flat to uneven
  • overpronate (your foot rolls inwards when you run)

There are certain factors in your body that can make you more susceptible to developing ITB syndrome too. These include having weak muscles in your hips or knees, tightness in your TB band, and having slight differences in the length of your legs.

Treatment for iliotibial band syndrome

The initial treatment for iliotibial band (ITB) syndrome aims to reduce your pain and the inflammation causing it. You can do this with rest, ice and medicines to reduce pain and inflammation. Further treatment includes stretching exercises and then strengthening exercises to gradually get you back to your usual activities. Most people return to their sport or running within four to six weeks.

You may find it helpful to see a sports medicine professional, such as a physiotherapist or a sports doctor. They will be able to diagnose and treat ITB syndrome. Your GP may be able to refer you, or you may be able to book an appointment with a physiotherapist directly.

Self help

It’s important that you stop doing the activity that brings on your pain. If you’re only getting mild pain, you may just be able to reduce your activity. For instance, stopping running before the time or distance when you normally get the pain. If your pain is more severe though, you should stop altogether. You can keep active by doing exercise which doesn’t bring on pain, such as swimming.

When you first develop ITB syndrome, it can help to apply ice or a cold compress to the painful area. Try applying it for 15–20 minutes at a time, every two to three hours. Don’t apply ice directly to your skin as it can give you an ‘ice burn’ – place a cloth between the ice and your skin.

Physiotherapy

Making sure you follow any physiotherapy and rehabilitation programme you’re given will be an important part of your recovery. Your physiotherapist will carefully assess your knee and plan an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles gradually.

Treatment usually involves manual techniques and stretching exercises at first. Your physiotherapist may suggest you try using a foam roll as part of a home exercise programme to help reduce your pain. You’ll then usually need to follow some specific strengthening exercises to help you recover. Finally, your physiotherapist will advise you on how to make a gradual return to your normal activity. Your physiotherapist may also give you some advice on how to try to prevent the problem coming back. They may advise you about changing your footwear to correct problems with your foot movement or look at your running gait on a treadmill.

Medicines

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help to ease your pain and reduce inflammation and swelling. You can buy ibuprofen over the counter. Your doctor may also be able to prescribe stronger NSAIDs if you need them. Always read the patient information that comes with your medicine, and if you have questions ask your pharmacist or GP for advice.

Your GP may recommend that you have a corticosteroid injection into the inflamed area if you have severe pain or swelling. This is unlikely to resolve your pain completely, but may give you enough pain relief to be able to continue with physiotherapy and rehabilitation.

Surgery

Surgery is not usually used as a treatment for iliotibial band (ITB) syndrome. Your doctor will only offer you surgery in very rare cases, where other treatments have failed.


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    • Iliotibial band syndrome. BMJ Best Practice. bestpractice.bmj.com, last reviewed February 2018
    • Lateral, medial and posterior knee pain. Brukner & Khan’s Clinical Sports Medicine (5th ed, online). McGraw-Hill Medical. csm.mhmedical.com, published 2017
    • Iliotibial band friction syndrome . Medscape. emedicine.medscape.com, updated 11 April 2016
    • Knee pain – assessment. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2017
    • Sprains and strains. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2016

  • Reviewed by Pippa Coulter, Freelance Health Editor, April 2018
    Expert reviewer, Elisabeth Morgans, Bupa Physiotherapist
    Next review due April 2021



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