IT band Friction Syndrome

What is it?
The iliotibial (IT) band is a thick, wide band of fascia that begins at the pelvis and runs down the lateral side of the thigh and attaches to the outside of the tibia (lower leg). The IT band helps provide some stability to the knee. IT band friction syndrome is a condition where an individual experiences pain over the lateral or outer aspect of the knee just above the joint line. The symptoms generally begin following repetitive flexion and extension of the knee. This condition is seen most commonly in running and cycling athletes.

How is diagnosed?
Usually, this diagnosis is made based on history and physical examination alone. Patients most frequently experience a rapid onset of burning pain at the lateral aspect of the knee shortly after beginning an exercise such as running or cycling. The symptoms can radiate along the course of the IT band up to the hip or down to the shin. There is generally marked tenderness over the lateral (outer) side of the knee.  No imaging studies are generally required, although at times x-rays or an MRI may be used to rule out other conditions.

Why does it happen?
As the knee flexes and extends (as with running), the IT band moves back and forth over a bony prominence on the femur (end of thigh bone) called the lateral epicondyle. Normally, there is a sac or bursa which allows the IT band to pass smoothly over the epicondyle. In individuals who have a tight IT band, the increased friction at the lateral epicondyle can cause inflammation and pain.

How is it treated?
Fortunately, the majority of IT band friction syndrome cases can be treated nonoperatively. Most cases are initially treated with activity modification, stretching exercises, and oral anti-inflammatories. Physical therapy can be very helpful to both identify and treat weaker muscle groups that can place an individual at risk for IT band syndrome. Occasionally a steroid injection is necessary to help reduce inflammation in the bursa lying beneath the IT band. In rare instances, surgery may be required. This type of surgery generally involves lengthening the IT band or releasing a portion of the fascia. Additionally, the inflamed bursa sac is also removed.