Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners, related to repetitive friction of the iliotibial band (ITB) sliding over the lateral femoral epicondyle.
Runners predisposed to this injury are typically in a phase of overtraining and often have underlying weakness of the hip abductor muscle. Male runners may exhibit kinematic faults such as increased hip internal rotation and knee varus, and weakness in the external rotator muscles of the hip. Female runners may exhibit increased hip adduction and knee internal rotation, and abnormal iliotibial band strain and strain rate.
In the acute phase, treatment includes activity modification, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injection in cases of severe pain or swelling.
During the subacute phase, emphasis is on stretching of the ITB and soft-tissue therapy for any myofascial restrictions.
The recovery phase focuses on a series of exercises to improve hip abductor strength and integrated movement patterns. The final return to running phase is begun with an every-other-day program, starting with easy sprints and avoidance of hill training with a gradual increase in frequency and intensity.
Surgery can be considered in refractory cases.
Impingement zone occurring at around 30° of knee flexion
From the personal collection of Dr J.C. Mak
- sharp or burning pain superior to the lateral joint line
- positive Noble test
- positive Ober test
- positive modified Thomas test
- pain on sitting or walking
- local edema
- reduced hip abductor muscle strength
- genu varum (bow leg)
- hindfoot and forefoot varum
- pes cavus (high arch)
- prominent lateral femoral epicondyle, tight iliotibial tract and tensor fascia lata
- weak gluteus medius, gluteus maximus, and tensor fascia lata
- tightness and weakness in the quadriceps, iliotibial tract, and lateral retinaculum
pain and inflammation
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- activity modification
- severe pain and swelling or refractory to nonsteroidal anti-inflammatory drugs (NSAIDs)/activity modification
- combination local anesthetic and corticosteroid injection
resolved pain and inflammation
- stretching exercises
- foam roll mobilization
- hip abductor strengthening
refractory to conservative treatment
- elective surgery