The iliotibial band (ITB) originates over the pelvic brim (iliac crest) and inserts onto the lateral shin bone (tibia). It is a thick, tight band of fascia and muscle. It passes over the thigh bone (femur) at a prominence called the greater trochanter. When the leg is straight, the iliotibial band is behind the trochanter. As the hip bends, the band moves over the trochanter and slides in front.
The trochanter juts out laterally beyond the shaft of the femur. There is a fluid filled sac called a bursa between the trochanter and the ITB. The bursa allows the muscle to glide smoothly over the bone. Tightness of the ITB may eventually lead to an inflammation of this bursa, causing hip bursitis. Bursitis is thickening and inflammation of the bursa, and may be very painful.
The most common symptom of greater trochanteric bursitis is pain at the point of the hip on the lateral thigh. The pain is initially sharp but later develops into a dull ache as it spreads across a larger area of the thigh. Laying on the affected hip makes this pain far worse. Other triggers include rising from a chair after being seated for extended periods of time. A tight ITB may also cause knee pain as the band passes over the lateral femoral condyle of the knee.
The easiest way to prevent hip bursitis and ITB syndrome is to work on your flexibility. These exercises are easy to do on your own. In some cases a physical therapist may teach you how to stretch your hip muscles and use other treatments such as ultrasound. Ice, heat and use of a foam roller also help a great deal. If you have lateral thigh pain and think you have hip bursitis, come and see a health professional to get started on the appropriate stretching regimen.
Your health professional may also consider starting an anti-inflammatory or providing you with a cortisone injection to help relieve the symptoms you are having. Pain in the back or groin is usually not caused by bursitis and warrants a trip to your health professional.
Thomas Barrett, MD
When we had patients come in with ITB syndrome, whether an athlete or not, I did have great success going after the hip stabilizers which in most of us are lacking correct position and strength. Always went after glute medius, primarily on the left side. Our pelvises are crooked due to internal asymmetrical weight of organs which are heavier on the right side. This pushes most of us to the right leg. I saw more ITB on the right than the left side.
The ITB takes over as a stabilizer when compensating for lack of glute med, glute max and hamstring strength. This does not mean that they are not working, only out of position and not firing as they should. It's like cylinders in a car. Car will work but not as efficiently as it should.
-- Patricia Schneider, PT-A