Iliotibial band syndrome (aka Iliotibial Band Friction Syndrome) describes an irritation of the tissues near the distal attachment of the iliotibial band. This overuse syndrome is particularly common in runners and cyclists. (1-3) This is a common issue Dr. Jolson treats with the Hincapie Racing Team.
The ITB is divided anatomically into two distinct portions- a proximal “tendinous” segment and a distal “ligamentous” component. (4) The proximal portion begins as a sheath encasing the tensor fascia lata muscle. This sheath anchors the tensor fascia lata to the iliac crest and also receives the majority of the gluteus maximus tendon. (5) The dense fibrous ITB then courses distally with a deep component that attaches to the femoral shaft via the strong lateral intermuscular septum and linea aspera. (4) Distally, the tendinous portion “fans” before terminating near the lateral epicondyle. (4) The ITB then transitions to its ligamentous component, spanning from the lateral epicondyle of the femur to Gerdy’s tubercle on the anterolateral aspect of the tibia. (5)
The iliotibial band is a conduit for forces generated by the TFL and gluteus maximus (i.e. thigh abduction, flexion, extension, and external rotation). The deep fascial component, which attaches to nearly the entire length of the femur, is most taut when the gluteus maximus and TFL contract. This “tensile” action significantly increases during single leg stance and serves to counteract medial bowing of the femur, while lateral bowing is minimized by “compression”. (4,6)
ITB syndrome is common in populations exposed to repetitive knee flexion and extension while in a single leg stance. (9) The problem is particularly prevalent in runners, where it comprises almost ¼ of all lower extremity injuries. (2,3,10-17) Ultimately, ITB syndrome affects up to 12% of all runners. (10) The condition is also frequently seen in cycling, weight lifting, skiing, soccer, basketball, field hockey, and competitive rowing.
The typical presentation for ITB syndrome is a runner or cyclist complaining of “sharp” or “burning” pain approximately 2 cm above on the outside of the knee – near the lateral femoral condyle. (9) Pain may radiate slightly above or below. (9) Symptoms are provoked by activities that require repetitive knee flexion and extension. Symptoms are more likely as activities proceed. (9) Less severe presentations may report pain only during activity, but as the condition progresses, symptoms become more persistent.
1. S. P. Messier, D. G. Edwards, D. F. Martin et al., “Etiology of iliotibial band friction syndrome in distance runners,” Medicine and Science in Sports and Exercise, vol. 27, no. 7, pp. 951–960, 1995.
2. Ellis R, Hing W, Reid D. Iliotibial band friction syndrome–a systematic review. Man Ther. Aug 2007;12(3):200-8.
3. Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). Jun 24 2008
4. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat, 2006;208:309-316.
5. Standring S. Gray’s Anatomy: the Anatomical Basis of Clinical Practice. 39. Edinburgh: Elsevier/Churchill Livingstone; 2004.
6. Michaud T. The Real Cause of Iliotibial Band Syndrome Dynamic Chiropractic November 18, 2012, Vol. 30, Issue 24
Fetto J, Leali A, Moroz A Evolution of the Koch model of the biomechanics of the hip: clinical perspective. J Orthop Sci. 2002; 7(6):724-30.
7. Drogset JO, Rossvoll I, Grøntvedt T Surgical treatment of iliotibial band friction syndrome. A retrospective study of 45 patients. Scand J Med Sci Sports. 1999 Oct; 9(5):296-8.
8. Fetto J, Leali A, Moroz A Evolution of the Koch model of the biomechanics of the hip: clinical perspective. J Orthop Sci. 2002; 7(6):724-30.
9. M. Fredericson and A. Weir, “Practical management of iliotibial band friction syndrome in runners,” Clinical Journal of Sport Medicine, vol. 16, no. 3, pp. 261–268, 2006
10. Linenger JMCC. Is iliotibial band syndrome overlooked? Phys Sports Med. 1992;20:98–108.