knee pain and joint careIliotibial Band Syndrome, or ITBS, is pain mostly on the lateral side of the knee, which tends to bother athletes in endurance sports such as distance (cross-country) running, cycling, hiking and military service. It’s often confused with “the other runner’s knee”: Patellofemoral Syndrome (PFS), which causes pain dominating the front of the knee or kneecap.

What is the Iliotibial Band?

The Iliotibial band is the longest, most massive tendon in our bodies. Unlike most tendons, it isn’t free to move. It’s anchored along the length of the femur. In the US, about 200,000 cases of ITBS occur annually, which tend to resolve within approximately three months. Recovery time varies, depending on how long you’ve been injured and how you respond to conservative treatment.

ITBS may initially strike with a stinging or needle-like pricking pain on the side of the knee. Orthopaedists believe that it may be caused from the knee-forward, semi-squatting postures running and hiking require. Hard-surface running on pavement may be also be a precipitating factor. Other signs and symptoms include:

  • Progression to pain each time your heel touches, or strikes, the ground
  • Eventually, disabling pain upon walking or climbing up and down steps
  • Sometimes, pain radiating along the entire course of the IT band, from the affected knee up to the outer thigh and hip.

Diagnosing Iliotibial Band Syndrome

To correctly diagnose ITBS pain, your orthopaedist will perform a helpful physical exam. He or she will often be able to palpate, or feel with trained fingers, the area of pain. Tenderness and swelling, or inflammation, can be detected over the femoral epicondyle, where your bursa or sac [of inflammation] is present. Often tenderness of the outer thigh occurs just above the knee joint; but the knee and hip usually are normal upon palpation. Your orthopaedist will also be ruling out other causes of knee pain by performing a physical exam.

Treatment Options for Iliotibial Band Syndrome

Conservative treatment consists of RICE: rest, ice, compression and elevation of the affected knee. Your physician may prescribe topical nonsteroidal anti-inflammatory medication for the pain. These are all effective in your initial phase of treatment. Then your orthopaedist will probably recommend a course of physical therapy, possibly including deep tissue massage and what is called biomechanical evaluation and correction of any limb-length discrepancies or unusual gait issues in your stride.

Although your IT band may feel “tight,” it’s hard to fix by stretching. describes the anatomy of the ITB as “a unique connective tissue structure with some properties of a tendon, some of a ligament, and an unusual tension control system consisting of a couple of hip muscles at the upper end.”

Injections for Treating ITBS

Another option is one or more corticosteroid injections, given with the understanding that the injection doesn’t cure the injury, but reduces your pain so you can move on to your next treatment phase. Sometimes this injection is given prior to rehabilitation exercises and treatments in physical therapy.

Rarely, surgery is needed; but is never indicated before a patient has failed three months of more conservative treatments. Orthopaedic surgeons often believe IT band “release” surgery is best offered primarily to patients highly motivated to return to their sports or activities. Arthroscopic surgery of the knee is used to locate the inflammation surrounding the IT band and excise it, or cut it away.

At Hampton Roads Orthopaedics and Sports Medicine, we are proud to have outstanding orthopaedic physicians, surgeons and physical therapists on staff; so if you suffer iliotibial band pain syndrome, you can have it diagnosed and treated within our practice. Please contact us at (757) 873-1554 or request an appointment online if we can assist you with this or any other orthopaedic issue.