What is the Iliotibial band (ITB)

The ITB is a band of thick fibrous connective tissue that runs from the lateral side of the pelvis down the outside of the thigh and inserts onto the lateral side of the tibial plateau

What does the band do?

The ITB transmits force from the hip muscles (glutes and Tensor fascia lata) down the outside of the thigh to the lower leg.  This transmission supports or helps to stabilise the knee.  In addition, there is assistance with flexion, extension, abduction, and laterally and medially rotation of the hip.

What is Iliotibial band friction syndrome

It is thought to be rubbing of the distal ITB against the lateral femoral condyle, fat pad and associated connective tissue or, inflammation of a bursae

Signs and symptoms

The main symptom from ITB syndrome is sharp pain on the outside of the affected knee.  This occurs particularly when the heel strikes the floor whilst walking or running.  Stairs can also be problematic particularly when descending them.  Sometimes there can be an audible snapping sensation and, some localised swelling can present on the outside of the affected knee.  There may also be some tenderness when palpating the lateral side of the knee over the distal femur.

Use of Renne’s test can also be an indicator but, there is not a huge amount of clinical validity in this test due to a limited amount of research. The test itself is a single leg squat to about 30-40 degrees flexion, reproduction of pain is a positive sign for ITB syndrome.

Management options

Activity modification, proximal hip abductor strengthening (evidence equivocal however for this). Correction of techniques and/or muscular imbalances.  Acute injury management methods such as icing and rest may also be helpful.

Glossary of terms

Medial and lateral = situated near the median plane of the body and, the region furthest from the median plane respectively

Distal and proximal = situated away from/near the centre of the body and, from/at the point of origin respectively.

Flexion and Extension = the action of bending or the action of moving a limb from a bent to a straight position respectively

Pelvis = the large bony frame near the base of the spine to which the legs are attached

Tibia = the inner and typically larger of the two bones between the knee and the ankle 

Femur = the bone of the thigh

Tibial Plateau the proximal end of the tibia that has a shelf like appearance and forms the distal part of the knee joint

Glutes = a group of three muscles which make up the gluteal region commonly known as the buttocks:

Tensor Fascia Lata = a muscle that overlies two the of the gluteal muscles and forms the iliotibial band. Bursae = a fluid-filled sac or sac like cavity, especially one countering friction at