Iliotibial (IT) Band Friction Syndrome

IT (iliotibial) band friction syndrome is one of the leading causes of knee pain in runners. The IT band is a long tendon that extends from the outer side of the pelvis (ilium) and runs along the side of the thigh to insert just below the knee on the upper part of the shinbone (tibia). IT band friction syndrome occurs when this tendon gets irritated or inflamed from overuse, causing pain and snapping on the outside of the knee.

What Causes IT Band Friction Syndrome?

The IT band is connected to the tensor fascia lata muscle, which is active during running. With every stride, the IT band moves back and forth across the bony prominence on the outside of the knee. This repetitive motion can create friction at the IT band, which leads to inflammation (swelling) and pain.

Training practices that can increase the risk for IT band friction syndrome:

  • Running on a banked surface like the shoulder of a road
  • Inadequate warm-up or cool-down
  • Excessive downhill running
  • Increasing distance or speed too quickly
  • Running up or down stairs
  • Excessive wear on the outside heel of running shoes

Biomechanical factors that can increase the risk for IT band friction syndrome:

  • Tight IT band
  • Weak hip muscles
  • Bowed legs
  • Unequal leg lengths
  • Foot shape: high arches, flat feet or excessive pronation

What Are the Symptoms of IT Band Friction Syndrome?

The main symptom is pain on the outside of the knee that occurs with running and generally improves with rest. Some people experience a snapping sensation at the outside of the knee with running. In more severe cases, the pain may also occur with walking or climbing stairs and may radiate up the thigh.

How Is IT Band Friction Syndrome Diagnosed?

Your doctor will review your symptoms and training habits. He/she will examine your hips and knees to locate the site of irritation and assess your strength and flexibility. Imaging studies such as X-ray or MRI are not needed to diagnose IT band friction syndrome. Your doctor may order imaging studies to evaluate for other causes of knee pain if the diagnosis is unclear.

How Is IT Band Friction Syndrome Treated?

Treatment requires a short period of rest from running and other painful activities to allow the inflammation to resolve and the tendon to heal. Applying ice to the painful area for 15 minutes several times a day will help to reduce pain and inflammation. Your doctor may also prescribe anti-inflammatory medication. A physical therapy program that includes hip muscle stretching and strengthening and IT band massage will take tension off the IT band, and can speed recovery and return to sports. Your doctor may recommend shoe inserts if your feet have low arches or excessive pronation. Rarely, surgery may be necessary to loosen the IT band if rest and physical therapy fail to relieve the symptoms.

How Can IT Band Friction Syndrome Be Prevented?

  • Start any new activity or running program slowly and progress gradually. Do not increase distance, intensity, or duration of your training by more than 10% per week.
  • Perform a proper warm-up before starting any activity. Ten minutes of light jogging, cycling, or calisthenics before practice will increase circulation to cold muscles, making them more pliable and less prone to strain or injury.
  • Wear shoes that fit properly and are appropriate for the sport or activity.
  • Replace worn out shoes promptly.
  • Avoid running on banked surfaces.
  • If running on a track, change the direction each time you run.
  • Stretch quadriceps, hamstrings, hip flexors, and gluteal muscles 1–2 times a day. The best time to stretch is after exercise. Hold each stretch for 30 seconds. Don’t bounce.
  • Do not play through pain. Pain is a sign of injury, stress, or overuse. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple of days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport. 

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