Iliotibial Band Syndrome (IT Band Syndrome)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What causes iliotibial band (IT band) syndrome?

Iliotibial band inflammation is an overuse syndrome that occurs most often in long-distance runners, bicyclists, and other athletes who repeatedly squat. The iliotibial band syndrome may be the result of a combination of issues, including poor training habits, poor flexibility of muscle, and other mechanical imbalances in the body, especially involving the low back, pelvis, hips, and knees.

There can be a predisposition to develop IT band syndrome. Anatomy issues may include differences in the lengths of the legs (a leg-length discrepancy), an abnormal tilt to the pelvis, or bowed legs (genu varum). These situations can cause the iliotibial band to become excessively tight, leading to increased friction when the band crosses back and forth across the femoral epicondyle during activity.

Training errors may cause runners to develop iliotibial band syndrome symptoms. Roads are canted or banked with the center of the road higher than the outside edge to allow for water runoff. If a runner always runs on the same side of the road, it produces the same effect on the body as having a leg-length discrepancy. One leg is always downhill compared to the other, and the pelvis has to tilt to accommodate the activity. Running too many hills can also cause inflammation of the IT band. Running downhill is especially stressful on the IT band as it works to stabilize the knee.

Bicyclists may develop IT band inflammation should they have improper posture on their bike and "toe in" when they pedal. The issue may be how the toe clips are aligned, forcing the foot to be internally rotated, toed in. This can cause the same effect as bowed legs, increasing the angle of the IT band as it crosses the knee and increasing the risk of inflammation.

Other activities with increased knee flexion can cause symptoms and include rowing and weight lifting, especially with excessive squatting.

What are iliotibial band (IT band) syndrome symptoms and signs?

Pain on the lateral side of the knee is the most common symptom of iliotibial band syndrome and is due to inflammation of the area where the band crosses back and forth at the femoral epicondyle. Initially, there may be a sensation of stinging or needle-like pricks that are often ignored. This can gradually progress to pain every time the heel strikes the ground and finally can become disabling with pain when walking or when climbing up or down steps.

Some patients may feel a snapping or popping sound at the knee, and there may be some swelling either where the band crosses the femoral epicondyle or below the knee where it attaches to the tibia. Occasionally, the pain may radiate along the course of the IT band all the way up to the outer side of the thigh to the hip.

Medically Reviewed by a Doctor on 2/22/2016

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