Clinical Notes : Orthopedics and Trauma

62. Iliotibial Band Syndrome


Iliotibial Band (ITB) Syndrome


Overuse injury causing pain on the outside part of the knee especially during running when the heel strikes the ground.


Iliotibial Band Syndrome (ITBS) affects primarily the outside of the knee (the lateral or outward-facing side of the knee).

Don’t confuse it with Patellofemoral Pain Syndrome (PFPS) which affects the kneecap and surrounding area. This picture is of a right knee.


  • Overuse injury leading to repetitive friction of the ITB sliding over the lateral femoral epicondyle

  • Predisposing factors include

    • excessive training load

    • over-training

    • downhill/distance running

  • Other factors that predispose an athlete to ITBS include

    • excessive internal tibial rotation

    • genu varum

    • increased pronation of the foot.



  • Pain is worse when the foot strikes the ground

  • May present as hip pain, over the greater trochanter



  • Commonest cause of lateral knee pain in runners.

  • Cyclists are at risk for ITB syndrome if they tend to pedal with their toes turned in (internally rotated), which can cause abnormal stretching of the iliotibial band at the knee.

  • Increased frequency in adolescents undergoing the rapid growth phase.


Diagnosis is clinical

  • history

  • positive Ober’s test


  • Acute phase - RICE

    • Rest

    • Ice

    • Compression

    • Elevation

  • Medication

    • NSAIDS

  • Sub-acute phase

    • ITB stretching

  • Chronic condition - refer for consideration

    • Ultrasound

    • Steroid injection

    • Surgery to lengthen the ITB


Video : Ober's Test and Modified Ober's Test

BMJ Best Practice.png

Practical management of iliotibial band friction syndrome in runners.

Fredericson M, Weir A.

Clin J Sport Med. 2006 May. 16(3):261-8.



Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment.

Baker RL, Souza RB, Fredericson M.

PM R. 2011 Jun. 3(6):550-61.



Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears.


Adams WB.

Curr Sports Med Rep. 2004 Oct. 3(5):256-60.


Iliotibial Pain Syndrome

BMJ Best Practice

Last reviewed: February 2019

Last updated: August  2018


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