Iliotibial Band Friction Syndrome (IT Band Syndrome, ITBFS)

A short, tight IT bandA very prominent lateral femoral epicondyle (bony structure on the outer side of the knee)Problems related to the foot or hipBowlegsInward rotation of the legLegs of different lengthsCertain sports with repetitive motions, such as running and cyclingRunning up and down hills Symptoms Symptoms of ITBFS include: Dull aching or burning sensation on the outside of the knee during activitySharp stabbing pain on the outside of the knee during activityThe pain may be localized, but generally radiates around the outside of the knee and/or up the outside of the thigh. Pain typically starts as minor discomfort and worsens progressively. Snapping, creaking, or popping may be present when the knee is bent and then straightened. There is usually no swelling. Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is based on these factors: Pain around the lateral femoral epicondyleTenderness when pressure is applied to this areaPain occurs when going from a straight leg to a bent kneeTests may include:Ober's testdetermines the tightness of the ITBRenne's testspecifies the area of pain while full weight is placed on the legNoble's testdetermines the area of pain while the leg is flexed at a certain angle

TreatmentTreatment depends on the cause.Treatment may include:Restrestriction from activities that cause pain.Heat or iceapplication of heat, ice, and/or ultrasound by appropriate professionals (Generally ice is applied after activity; heat may be used before exercise to loosen muscles and soft tissues.)Exercisestretching to lengthen the ITB and strengthening the quadriceps and hamstrings to correct muscle imbalances.Correct techniqueevaluating and correcting running, cycling, and weight-training techniques.Orthoticscustom orthotic supports to correct foot problems.Medicationsanti-inflammatory medications and/or local cortisone injections.Surgeryonly for extreme cases where other treatment options have failed. Prevention Avoiding the causes of ITBFS is the best way to prevent it. This can include: Learning proper training techniquesWearing appropriate shoes for each sportReplacing athletic shoes as they show signs of wearBeing aware of running surfacesUsing properly-fitted equipmentIncreasing mileage run and weight lifted gradually, and when lifting weights doing small increments each dayStrengthening quadriceps and hamstringsStretching the ITBSeeing a foot specialist for evaluation and orthotics, if necessary RESOURCES:

American Academy of Orthopaedic Surgeonshttp://orthoinfo.aaos.org American Orthopaedic Society for Sport Medicinehttp://www.sportsmed.org American Running Associationhttp://www.americanrunning.org CANADIAN RESOURCES: Canadian Orthopaedic Associationhttp://www.coa-aco.org/ Canadian Orthopaedic Foundationhttp://www.canorth.org/default.asp The University of British Columbia Department of Orthopaedicshttp://www.orthosurgery.ubc.ca/index.html References: National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ . Wheeless' Textbook of Orthopedics . 1996. Last reviewed January 2008 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.