IT Band Syndrome

The iliotibial band is the tendon attachment of hip muscles into the upper leg (tibia) just below the knee to the outer side of the front of the leg. Where the tendon passes the knee (lateral femoral condyle) there is a bursa sac between the bone and the tendon. This tendon moves over a bony bump at the outer knee as it passes in front and behind it. The bursa functions like a water balloon to reduce friction and wear of the tendon against the bony bump. In this condition, overuse causes excessive friction at this bump, resulting in inflammation and pain of the bursa (bursitis), tendon (tendinitis), or both.

Common Signs and Symptoms of IT Band Syndrome

  • Pain, tenderness, swelling, warmth, or redness over the iliotibial band at the outer knee (above the joint); may travel up or down the thigh or leg
  • Initially, pain at the beginning of an exercise that lessens once warmed up; eventually, pain throughout the activity, worsening as the activity continues; may cause the athlete to stop in the middle of training or competing
  • Pain that is worse when running down hills or stairs, on banked tracks, or next to the curb on the street
  • Pain that is felt most when the foot of the affected leg hits the ground
  • Possibly, crepitation (a crackling sound) when the tendon or bursa is moved or touched

IT Band Syndrome Causes

Iliotibial band syndrome is caused by excessive friction of the iliotibial band and the underlying bursa due to repetitive knee-bending activities. This is an overuse injury, although direct trauma to the outer knee may cause the bursa to get inflamed. Often the deceleration of running down hills may lead to the excessive friction.

IT Band Syndrome Risk Increases With:

  • Sports with repetitive knee-bending activities, such as distance running and cycling
  • Incorrect training techniques, including sudden changes in the amount, frequency, or intensity of the training, as well as inadequate rest between workouts
  • Poor physical conditioning (strength and flexibility), especially tight iliotibial band
  • Inadequate warm-up before practice or play
  • Bow legs
  • Arthritis of the knee

IT Band Syndrome Preventive Measures

  • Appropriately warm up and stretch before practice or competition.
  • Allow time for adequate rest and recovery between practices and competition.
  • Maintain appropriate conditioning:
    • Knee and thigh flexibility (particularly with iliotibial band)
    • Muscle strength and endurance
    • Cardiovascular fitness
  • Use proper training technique, including reducing mileage run, shortening stride, and avoiding running on hills and banked surfaces.
  • Wear arch supports (orthotics) if you have flat feet.

Expected Outcome

IT Band Syndrome is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.

Possible Complications

  • Prolonged healing time if not appropriately treated or if not given adequate time to heal
  • Chronically inflamed tendon and bursa, causing persistent pain with activity that may progress to constant pain
  • Recurrence of symptoms if activity is resumed too soon through overuse, a direct blow, or poor training technique
  • Inability to complete training or competition