Iliotibial Band Syndrome

Definition/diagnostic criteria Iliotibial band syndrome (ITBS) is a common cause of lateral knee pain, primarily attributed to inflammation of the iliotibial band (ITB), a thick band of fibrous tissue that runs down the outside of the thigh from the hip to the shin. ITBS occurs when the ITB becomes tight or inflamed, leading to pain typically centred on the lateral aspect of the knee, where the ITB crosses the joint. The condition is often diagnosed clinically, based on patient history and physical examination findings, including the presence of tenderness over the lateral epicondyle of the femur, approximately 3 cm above the knee joint.

Epidemiology ITBS is one of the most common causes of lateral knee pain, especially among runners and cyclists. It accounts for around 12% of all running-related injuries and 15–24% of all cycling injuries. The prevalence is slightly higher in females compared with males, primarily due to biomechanical differences.

Diagnosis
Clinical features: Patients typically present with a history of pain on the outer side of the knee, often exacerbated by activities such as running or cycling, especially when performed over long distances or at high intensities.

• The pain is typically sharp and intense, and it may radiate along the length of the ITB.
• Physical examination might reveal tenderness at the lateral epicondyle of the femur, pain on flexion and extension of the knee, and a positive Ober’s test, indicating tightness of the ITB.

Investigations: While the diagnosis of ITBS is primarily clinical, imaging modalities such as ultrasound or MRI may be used to rule out other pathologies. These investigations may show thickening of the ITB at the lateral epicondyle of the femur, bursitis or fluid collection around the ITB. However, these findings are not specific to ITBS and should be interpreted in the context of the clinical presentation.

Treatment Management of ITBS is largely conservative.

• Rest and activity modification: Patients should be advised to avoid activities that exacerbate symptoms.
• Physical therapy: Stretching and strengthening exercises targeting the hip abductors, quadriceps, and hamstrings can be beneficial.
• Pharmacological interventions: The use of NSAIDs can be considered for short-term pain relief.
• Local injections: Corticosteroid injections may be considered in cases not responding to conservative treatment. However, they should be used cautiously due to potential adverse effects, including weakening of the surrounding tissues.

Prognosis The prognosis for ITBS is generally good, with most patients responding well to conservative treatment. Full recovery can be expected within a few weeks to months, depending on the severity of the condition and adherence to the treatment regimen. Recurrence is common, especially if the underlying biomechanical or training-related causes are not addressed.