A condition that mostly affects athletes and causes aching and sharp pain on the outside of the knee or hip is called iliotibial band syndrome (ITBS). Generally, the iliotibial band is a tendon that may rub against the knee bones and hip. While the most common symptoms of ITBS are irritation and swelling, it may also cause other symptoms. Doctors often treat this condition with medicines, physical therapy, or surgery (rarely).
Moreover, the tendon that is affected runs from the top of the pelvic bone down to the knee. Usually, it rubs against the knee or hip when it gets too tight (tense). In normal circumstances, tendons are flexible, elastic-like fibrous tissues that connect the muscles to the bones. They also help pull on the bone when you squeeze a muscle, which helps the bone move. When this condition affects both legs, it is called bilateral iliotibial band syndrome.
According to some data, ITBS mostly affects U.S. Marines during training. About 20% of them will develop ITBS at some point. In addition, knee pain that occurs in adults is often caused by this syndrome, and it affects about 25% of adults.
What Are The Symptoms of Iliotibial Band Syndrome?
The primary symptom of this syndrome is pain that often appears after exercise. When the condition worsens, you will feel pain all the time you exercise and even when you are resting. Check for other symptoms of ITBS below:
- Hip pain – This symptom happens because the tendon continuously rubs against the greater trochanter in the hip. This is the area where the bone widens (near the top of the femur). Prolonged friction causes the tendon to become inflamed.
- Clicking sensation – Sometimes, people who are affected by this syndrome may feel a snap, pop, or click on the outside of the knee.
- Knee pain – In this case, the lateral epicondyle, which is located on the outside of the knee near the bottom of the femur, rubs against the iliotibial band. As a result, the knee extends and becomes inflamed.
- Redness and warmth – This is another symptom of ITBS that causes the outside of the knee to look discolored and feel warm.
Do not hesitate to visit a doctor if any of the previous symptoms occur. Early detection and prompt treatment may help reduce recovery time and prevent complications. Most of the time, people describe the initial pain as aching and burning. During exercise, they may notice that the symptoms worsen and the pain becomes sharp.
Causes
This syndrome may occur for different reasons. Check the most common causes of ITBS below:
- Excessive foot pronation – The foot rotates outward naturally, which may stretch the iliotibial band, causing it to get closer to the bone.
- Hip abductor weakness – The term abductor means the way the hip turns away from the body. The iliotibial band may become tight when the ability to rotate the hip weakens.
- Internal tibial torsion – It occurs when the tibia (also known as the shinbone) is twisted inward toward the body. As a result, it pulls the iliotibial band close to the bone.
- Medial compartment arthritis – It happens in the knee joint, and it may spread when the feet touch the ankles.
- Preexisting iliotibial band tightness – Sometimes, the iliotibial band tightness is present at birth (congenital).
Check below for some reasons why the iliotibial band rubs against the bones:
- Lack of rest or stretching before physical exercise
- Running downhill or on a tilted surface
- Warming up too quickly before exercise
- Worn-out shoes
- Performing intense physical exercise
- Cooling down too quickly, particularly after exercise
Risk Factors
While anyone can develop ITBS, some factors may increase your risk even more. Check some examples below:
- Athletes – Usually, runners, skiers, soccer players, hockey players, cyclists, and basketball players are at increased risk for ITBS.
- Bowed legs
- Knee arthritis
- One leg is longer than the other
- Rotating the ankle, leg, or foot inward while moving
- Muscle weakness in the hip, buttocks, or abdomen
What Happens if Iliotibial Band Syndrome is Left Untreated?
People who leave this condition untreated may also experience some complications. Check some examples below:
- Chronic pain
- Persistent joint stiffness, which may also lead to reduced flexibility and loss of full range of motion
- Joint instability
- Patellofemoral pain syndrome (PFPS) – It happens when the pain appears around and under the patella (kneecap).
- Trochanteric bursitis – It causes inflammation of the bursa and muscle tightness.
- Secondary tendonitis
- Chronic (long-term) inflammation
The previous list does not contain all possible ITBS complications. In any case, doctors may help reduce the risk or even prevent some of them.
How Long Does it Take to Recover from Iliotibial Band Syndrome?
Approximately 75% of people with this syndrome recover between 4 and 8 weeks with treatment.
How to Prevent Iliotibial Band Syndrome?
Usually, it is quite difficult to prevent this condition, especially if you are an athlete. However, doctors may recommend changing the way you perform physical activity, which may help reduce the risk. Check some examples below:
- Avoid running up or down a hill
- Always use protective equipment to prevent injuries
- Shift training intensity gradually
- Wear supportive shoes
- It is also recommended to warm up and cool down slowly
Diagnosis
Like the diagnosis of many other health conditions, the ITBS diagnosis begins with a physical examination in which doctors will check for abnormalities linked to the disease. When doctors are not sure about the diagnosis, they may perform some tests that will help rule out other conditions that cause similar symptoms to ITBS. Check some of them below:
- Noble and Ober test – This test includes several steps. For example, feeling the lateral epicondyle on the outside of the knee, moving the hip away from the body while supporting the knee, and moving the knee at different angles to determine whether it causes pain.
- Ultrasound – It helps doctors determine how the iliotibial band moves.
- MRI (magnetic resonance imaging) scan – This is another imaging test used to get detailed images of the iliotibial band and nearby structures.
Treatment
While some treatments can be done at home, others should be given under medical supervision. Check some examples below:
- Rest – According to some research, people who develop ITBS should not exercise, especially if they experience pain.
- Pain relievers – Doctors may recommend NSAIDs (nonsteroidal anti-inflammatory drugs), such as Naproxen or Ibuprofen, to ease pain caused by your condition.
- Manual therapy – During this procedure, therapists will teach you how to use a foam roller to massage the body (including the affected areas).
- Physical therapy – This treatment is often recommended by doctors to strengthen and stretch the hip and knee. Usually, it helps reduce pain and decrease tension in the iliotibial band.
- Posture training – In general, it is important to know the way you hold your body when performing physical exercise.
- Steroid injections – In more severe cases, doctors may recommend these injections to reduce inflammation.
- Surgery – This treatment is rarely recommended for people with ITBS. Commonly, people need it when the previous options do not work.
Frequently Asked Questions
What does iliotibial band syndrome feel like?
Iliotibial band syndrome (ITBS) commonly causes aching, burning, or sharp pain on the outside of the knee. The pain may initially occur only during exercise, especially activities involving repetitive knee bending, but it can become more persistent as the condition worsens. Some people may also experience pain on the outside of the hip or a clicking or snapping sensation.
Is iliotibial band syndrome more common in runners?
Yes. ITBS is particularly common among runners because repetitive knee movement can irritate the iliotibial band. Runners who frequently train downhill, run on banked or uneven surfaces, increase their training suddenly, or do not allow enough recovery time may have a higher risk of developing the condition.
Can you walk with iliotibial band syndrome?
Many people with mild ITBS can walk, although walking may become uncomfortable when the condition is more severe. Activities that repeatedly bend and straighten the knee can aggravate symptoms. If walking causes significant pain, it is generally advisable to reduce activity and seek medical guidance.
How is iliotibial band syndrome different from a meniscus injury?
ITBS usually causes pain on the outside of the knee, particularly during repetitive activities such as running or cycling. A meniscus injury may also cause knee pain but can be associated with swelling, catching, locking, or difficulty moving the knee. Because several knee conditions can cause similar symptoms, a healthcare professional may need to examine the knee to determine the cause.
Should I stretch the iliotibial band if I have ITBS?
Stretching may be included in a rehabilitation program, but treatment should not focus only on stretching the iliotibial band. Physical therapy may also involve strengthening the hip and buttock muscles, improving movement patterns, and gradually returning to activity. A physical therapist can recommend appropriate exercises based on the severity of the condition.
Can iliotibial band syndrome go away on its own?
Mild ITBS may improve when the activity that triggers the pain is reduced or temporarily stopped. However, persistent or recurring symptoms may require treatment such as physical therapy and changes to training habits. Continuing activities that repeatedly cause pain can delay recovery.
Can iliotibial band syndrome cause permanent damage?
ITBS usually does not cause permanent damage when it is appropriately managed. However, continuing strenuous activity despite pain can contribute to persistent symptoms and make recovery more difficult. A healthcare professional can help identify contributing factors and develop a safe rehabilitation plan.
How long should I stop running with iliotibial band syndrome?
There is no single amount of time that applies to everyone. Runners may need to temporarily stop or modify activities that cause pain until symptoms improve. A gradual return to running is generally recommended once everyday activities and rehabilitation exercises can be performed without significant pain.
Can new shoes help prevent iliotibial band syndrome?
Supportive, properly fitting shoes may help reduce contributing factors in some athletes, particularly when worn-out footwear affects running mechanics. However, shoes alone cannot prevent ITBS. Gradually increasing training intensity, allowing adequate recovery, strengthening the hips and legs, and avoiding sudden changes in training are also important.
When should I see a doctor for iliotibial band syndrome?
You should consider seeing a healthcare professional if pain persists despite reducing activity, repeatedly returns during exercise, interferes with walking or daily activities, or becomes severe. Medical evaluation is also important if there is substantial swelling, inability to bear weight, significant injury, or symptoms that suggest another knee or hip condition. If you have any other questions, ask your healthcare professional.
