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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How do health-care professionals diagnose iliotibial band (IT band) syndrome?

Often, the diagnosis of iliotibial band syndrome can be made by the patient's story of symptoms. The patient describes the progression of lateral knee pain that is made worse when the heel strikes the ground. Physical examination is helpful because the area of pain can often be palpated with tenderness and swelling felt over the femoral epicondyle, where the bursa or sac is located.

The health-care professional may also look for leg-length discrepancy, muscle imbalance, and tightness in the legs and back. There is tenderness of the outer thigh just above the knee joint, while the knee and hip joints themselves are normal to examination.

Usually, a full physical examination of the low back and legs, including the hips, knees, and ankles, is performed to detect other potential causes of lateral knee pain.

Plain X-rays are not usually required to help with the diagnosis, but MRI may be used to look for inflammation surrounding and beneath the iliotibial band. The MRI can also exclude other causes of outer knee pain. These include torn cartilage (lateral meniscus tear), sprained lateral collateral ligament, and muscle tendon inflammation. Usually, imaging is not needed.

What is the treatment for iliotibial band (IT band) syndrome?

Iliotibial band syndrome is an overuse injury that causes inflammation. Initial treatment includes rest, ice, compression, and elevation (RICE).

Anti-inflammatory medications, like ibuprofen (Advil, Motrin) and naproxen (Aleve), may be helpful. Note that any over-the-counter medications can have potential side effects, as well as interactions with prescription medications. If questions or concerns exist, it is wise to ask a health-care professional or pharmacist about their safe use.

Home treatment can involve stretching, massage, and use of foam rollers at the site of pain and inflammation.

Should these first-line treatments not work, physical therapy may be needed to decrease the inflammation at the IT band. Some treatments focus on flexibility and stretching. Friction rubbing may occur over the IT band at the femoral epicondyle to break down inflammation and scarring.

Therapeutic ultrasound techniques may be used, including phonopheresis (ultrasound propels anti-inflammatory medications through the skin into the inflamed tissue) and iontophoresis (electricity is used instead of ultrasound).

The physical therapist may also help evaluate the underlying cause of the problem and look at muscle strength and balance and/or flexibility and gait analysis (watching a person walk, run, or cycle). Shoe orthotics may be useful if there is a gait problem, pelvic tilt, or leg-length discrepancy as a potential cause of IT band syndrome.

Corticosteroids (dexamethasone, methylprednisolone, hydrocortisone) injected at the site of inflammation may be of benefit.

It is unusual that the conservative nonsurgical treatment fails to help. However, orthopedic surgery may be an option for patients who fail conservative (nonoperative) treatment. Arthroscopy can be used to find the inflammation surrounding the iliotibial band and cut it away. This inflammation and scarring is often found in the lateral recess of the knee between the IT band and the femoral epicondyle. Other surgical options may be available, including cutting out a small triangular part of the IT band to lengthen the band and allow more room for it to slide across bone.

What stretches and exercises are beneficial for iliotibial band (IT band) syndrome?

Pictures of stretches for IT band syndrome
A. Hands are held on the waist, and the injured leg is crossed behind the good leg. B. The arm on the same side as the injured leg sweeps up and over as the hips are moved laterally toward the good side, allowing a lateral bend at the waist. There should be no twisting with this stretch and no need to touch the foot of the injured leg.
Medically Reviewed by a Doctor on 2/22/2016

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