Iliotibial band syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 19, 2016
StartDiseasesIliotibial band syndrome

Iliotibial band syndrome (ITBS) is a common overuse injury that can happen to anyone, but occurs most often as a sports injury among athletes such as distance runners, cyclists, and weight lifters. It most frequently strikes people that are between the ages of 19 and 40 years old.


Definition & Facts

The iliotibial band (ITB) is the name of the tendon that begins at the pelvic bone, proceeds down the length of the thigh, and connects again at the shin (tibia). It is normally fairly supple, smoothly gliding across the surface of the thigh bone (femur) while the leg is in motion, and helps to provide stability to the knee during movement. When this connective tissue is overused, however, it causes painful friction between the tendon and the thigh bone.

Symptoms & Complaints

People that have been diagnosed with iliotibial band syndrome have reported the following symptoms: 

  • Pronounced hip pain, thigh pain, and/or knee pain that worsens whenever the heel of the foot strikes the ground during long distance walking or running
  • Leg pain that is made worse by climbing stairs
  • Inflammation/swelling in the knee area or in the upper tibial area where the descending portion of the band attaches to the shin
  • A distinctive "popping" sensation in the hip, thigh, or knee on exertion
  • Pain that radiates down the length of the leg 
  • An uncomfortable "tingling" sensation that become painful over time.


Several factors can contribute to the development of ITBS. Physical causes of this condition can include: having one leg that is shorter than the other, a bowing-out of the lower legs, and having an abnormally or unusually tilted pelvis.

Non-physical factors include using poor training habits such as improperly stretching or warming up before working out or running, exercising beyond the body's capabilities, over-training, improper body positioning while exercising, running on uneven surfaces, running in hilly terrain, and any exercise that causes excessive or abnormal knee flexion.

Diagnosis & Tests

Most cases of ITBS can be correctly diagnosed based solely on a patient's physical symptoms and with a simple physical examination. Sometimes a more in-depth exam may be required to accurately diagnose the problem. A typical physical exam to check for ITBS involves checking for swelling and tenderness in the region of the lateral femoral epicondyle located on the side of the knee. A physical exam may also find areas of tenderness along the outside of the thigh area near where the band crosses from the lower thigh to the knee.

The hips, knees, legs, lower back and legs are also examined to rule out other potential causes of the discomfort. In some difficult to diagnose cases, the doctor may order a magnetic resonance imaging (MRI) scan to gain a better view of what is going on underneath the surface. This scan may also be order to rule out other possible causes of the patient's pain and other symptoms.

Treatment & Therapy

Once diagnosed with ITBS, it is important to closely follow the physician's orders and properly rest the area for the best possible outcome. Attempting to circumvent or shorten the recovery stage will result in re-injuring the tendon and prolonged recovery time. The worse case scenario is risking permanent damage to the tendon that may require surgery to treat and correct the problem.

As with many injuries that result from overuse, the initial recommended treat for ITBS may include R.I.C.E. therapy (rest, ice, compression, and elevation) in an effort to provide relief from some of the more immediate symptoms. Other suggested treatment options include the use of over-the-counter nonsteroidal anti-inflammatory drugs (such as ibuprofen), stretching exercises, and therapeutic massage that can be performed at home in most cases.

In some cases, physical therapy sessions may need to be prescribed for ITBS cases that do not respond well to more conservative at-home treatments. The use of ultrasound therapy can also help reduce inflammation. Patients that suffer from a case of leg-length issues may need shoes with special inserts to help correct the deficit.

In rare cases where all of the above treatments fail to provide measurable relief to the patient, surgery may be needed to correct the problem. Surgery can be performed by arthroscopic means and usually results in an easier recovery period than surgery performed with larger incisions. Depending upon the extent of the ITBS injury, recovery time can range anywhere from 8 weeks to 6 months or longer.

Prevention & Prophylaxis

One of the best ways to help prevent ITBS is by employing the use of proper stretching exercises before performing any activity that requires repetitive use of the hips, knees, or legs. Doing this allows the muscles, tendons, and ligaments time to properly warm up before engaging in activities that may cause damage to tendons, ligaments, and muscles.

There are specific exercises designed to help strengthen hip and gluteus muscles and prevent exercise-induced injuries. Lying on the floor and slowly raising the hips will give them a good stretch. Using flexible bands to provide gentle resistance will also help to stretch and strengthen the tendon. The use of a specially designed foam roller is another excellent way to perform a proper stretch to the iliotibial band. It can be use as a massage tool to help loosen the tight tendon and provide pain relief.

Runners that suffer from ITBS should avoid running on uneven surfaces, especially if they have one leg that is slightly longer than the other. Cyclists should ensure that their bikes are properly fitted to their height and leg length. Improperly fitting equipment can greatly contribute to the development of ITBS.