ITB Friction Syndrome

Iliotibial band

ITB friction syndrome is characterised by pain that is localised over the lateral femoral epicondyle (outside of the knee) that occurs during vigorous walking, hiking or running. The pain is usually relieved by rest and by walking with the knee held in full extension. However, when ambulation and knee flexion are resumed, symptoms return.

What is the iliotibial band? What causes ITB friction syndrome? What are the symptoms? How is ITB friction syndrome diagnosed? Can ITB friction syndrome be treated without surgery? What operation may be beneficial?

The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running. It moves from behind the femur (thigh bone) to the front while walking. The continual rubbing of the band over the bony prominence on the outside of the knee (lateral femoral epicondyle), combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Overuse may cause shortening of the ITB. The knee goes from flexion to extension and excessive pressure from the ITB causes friction over the lateral femoral epicondyle. This repeated motion produces inflammation of the underlying structures and causes pain.

Pain localized over lateral femoral condyle (outside of the knee) that is made worse with activity. Initially it is relieved by rest. Knee swelling, locking or giving way are NOT present. Downhill running seems to make it worse.

History and examination can usually make the diagnosis. Occasionally an MRI will be performed. An injection around the ITB may also help with the diagnosis.

The majority of patients respond to conservative management. Rest, ice, stretching, physiotherapy, and avoiding aggravating activities will all aid in recovery. Surgery is only used as a last resort when non-operative measures have failed. This is uncommon.

In rare cases consideration can be given to surgically lengthening the ITB.

Learn more about ITB Release surgery at SOTRS