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.
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:
Biomechanical factors that can increase the risk for 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.
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.
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.