What is the ilio tibial band?


The ilio tibial band (ITB) is a large, broad tendon that originates at the top of your pelvis, on the outside (lateral side) of your hip, and runs the length of the lateral side of your thigh and knee, eventually inserting on the lateral side of your shin bone (the tibia), just below the knee joint. 


Irritation of the ITB on the lateral aspect of the knee is referred to as “ITB friction syndrome”.  This is most common in people who participate in running and cycling. It falls into the category of overuse injuries and is a result of repetitive “rubbing” of the ITB over the bony prominences of the outside of the knee (lateral femoral condyle).


What are the symptoms of ilio tibial band friction syndrome?


Pain on the lateral side of your knee during or after exercise is the most common symptom of ITB friction syndrome.  You may notice that the pain sets in after you begin exercising, and dissipates when you stop.  Runners may note that this vague, diffuse pain comes on at a certain mileage and then as the inflammation worsens the symptoms occur at lesser distance intervals.  You may also experience a “snapping or popping” sensation along the lateral side of the knee with flexion and extension of the knee.  This is a result of inflammation of the ITB as it passes over the bony prominences of the knee.  Since the ITB spans the entire length of your thigh, you may feel the symptoms travel up the outside of your leg.  Sometimes patients may have pain on the upper thigh on the outer boney prominence of the hip joint (“Greater trochanteric bursitis”)


How is ilio tibial band friction syndrome diagnosed?


Most of the time, the diagnosis can be made in the office setting.  Your orthopedic physician can perform several clinical tests to confirm the diagnosis.  Occasionally, an MRI may be ordered if your physician suspects underlying damage within the knee joint, since ITB friction syndrome can mimic a lateral meniscal (cartilage) tear.  However, if there is no history of injury to the knee, and your onset of symptoms is consistent with those described in the paragraph above, then it is unlikely that you would have a lateral meniscal tear.  It is also unlikely to have fluid in the knee joint with an ITB syndrome whereas swelling could occur with a meniscal tear or knee arthritis.


How is ilio tibial band friction syndrome treated?


ITB friction syndrome is virtually always treated non-surgically.  Physical therapy is recommended to work on very specific stretches for the ilio tibial band.  Modalities such as moist heat can be used to “loosen up” the area prior to stretching, and ice can be used after stretching to “cool down” the area and minimize any post-stretching soreness.  It is not unusual to require 6-12 weeks of physical therapy before symptoms are resolved.  You may continue to participate in physical activity during rehabilitation on an “as tolerated” basis.  A variety of stretching exercises can be performed such as cross legged toe touches and cross legged wall leans to help regain flexibility.  Perform your stretches prior to running, run until the symptoms occur and then stop and stretch again,  Finally at he conclusion of you run “cool down” and stretch again.