Iliotibial Band Syndrome

What is iliotibial band syndrome (ITBS)?

Iliotibial band syndrome is where a tendon called the iliotibial band gets irritated or swollen from rubbing against your hip or knee bones. The tendon is on the outside of your leg, and it goes from the top of your pelvic bone down to your knee. It rubs against your bones when it gets too tense (tight). There are many reasons why your iliotibial band might tighten.

Tendons are flexible, elastic-like fibrous tissues that connect your muscles to your bones. Your tendon pulls on the bone when you squeeze a muscle, and that makes your bone move.

What are the types of iliotibial band syndrome?

You can have iliotibial band syndrome in one leg, or you can have it in both legs. When you have ITBS in both legs, it's called bilateral iliotibial band syndrome.

Who does iliotibial band syndrome affect (ITBS)?

You’re at a higher risk for iliotibial band syndrome if you’re young and exercise frequently. Examples of athletes who are most prone to ITBS include:

• Basketball players.
• Cyclists.
• Hockey players.
• Runners.
• Skiers.
• Soccer players.

Even if you're not an athlete, there are still some traits that give you a slightly above average chance of getting iliotibial band syndrome. Reasons include:

• Bowed legs.
• Having one leg that’s longer than the other.
• Knee arthritis.
• Rotating your ankle, leg or foot inward when you move.
• Weakness in your hip muscles, butt muscles or abdominal muscles.

How common is iliotibial band syndrome?

Experts note that iliotibial band syndrome often affects U.S. Marines during training. More than 20% get iliotibial band syndrome. Frequent runners, especially long-distance runners, are also prone. Iliotibial band syndrome accounts for about 12% of running injuries. More females than males have iliotibial band syndrome.

Knee pain — of which iliotibial band syndrome is one of many causes — affects as many as 25% of adults.

What causes iliotibial band syndrome?

Your iliotibial band gets irritated and swollen when it’s stretched too tight and rubs against bone. Possible causes of a tight iliotibial band include:

• Excessive foot pronation: Your foot naturally rotates outward. That stretches the iliotibial band and brings it closer to your bones.
• Hip abductor weakness: Abduction of the hip is when your hip turns away from your body. A weakened ability to rotate your hip might cause your iliotibial band to tense.
• Internal tibial torsion: Your tibia is also called your shinbone. Internal tibial torsion is when your tibia is twisted inward toward your body. This pulls your iliotibial band closer to your bones.
• Medial compartment arthritis leading to genu varum: Medial compartment arthritis happens in your knee joint. Genu varum causes your knees to spread when your feet touch your ankles. This pulls on your iliotibial band, tightening it.
• Preexisting iliotibial band tightness: It’s possible that you just happened to be born with a tighter iliotibial band.

Your tight iliotibial band might rub against your bones for reasons that include:

• Cooling down too quickly after exercising.
• Lack of rest.
• Not stretching enough before exercising.
• Pushing yourself too hard during exercise.
• Running on a tilted or curved surface.
• Running downhill.
• Warming up too quickly before exercising.
• Worn out shoes.

What are the symptoms of iliotibial band syndrome (ITBS)?

A tense iliotibial band can cause several symptoms:

• Hip pain: Your iliotibial band repeatedly rubs against your greater trochanteric in your hip. Your greater trochanteric is where the bone widens near the top of your femur. The friction causes inflammation in your tendon and pain in your hip. You might hear a snapping sound.
• Clicking sensations: You might feel a snap, pop or click on the outside of your knee.
• Knee pain: Your lateral epicondyle is on the outside of your knee near the bottom of your femur, where the bone widens. Your tense iliotibial band repeatedly rubs against your lateral epicondyle when you flex and extend your knee. The friction causes inflammation in your tendon and pain in your knee.
• Warmth and redness: The outside of your knee might look discolored and feel warm to the touch.

At first, the pain will start after you exercise. As the syndrome worsens, you’ll feel it the whole time you exercise and, eventually, also when you’re resting.

What does iliotibial band syndrome feel like?

People with iliotibial band syndrome describe the initial pain as aching and burning. The more they exercise their leg, and the worse the syndrome gets, the sharper the pain turns. Tell your healthcare provider not just where the iliotibial band syndrome pain is but what it feels like.

How is iliotibial band syndrome diagnosed?

Your healthcare provider might diagnose you with iliotibial band syndrome after discussing your history of exercise and symptoms and performing a physical examination. Your provider should check for the following signs of ITBS:

• Grating sounds or a grating feeling (crepitus) when your knee or hip moves.
• Pain over the greater trochanter in one or both of your hips.
• Pain at the lateral epicondyle in one or both of your knees.
• Pain that increases the longer you exercise.
• Pain that’s worse when you go downhill.

What tests are done to diagnose iliotibial band syndrome (ITBS)?

Your healthcare provider might perform a test called the Noble and Ober test. There are several steps that include:

• Feeling your lateral epicondyle on the outside of your knee to see if your iliotibial band syndrome pain is coming from that spot.
• Moving your hip away from your body while supporting your knee. You might feel pain and be unable to move your hip very far.
• Moving your knee at different angles to see if that causes pain.

Correct diagnosis of iliotibial band syndrome also requires imaging tests, including:

• Magnetic resonance imaging (MRI): Your healthcare provider might order an MRI if they're unsure about your diagnosis. The MRI should help them with a process of elimination by excluding other injuries like a meniscal tear or a lateral collateral ligament (LCL) injury.
• Ultrasound: An ultrasound can prove that you have iliotibial band syndrome by showing how your iliotibial band moves when you flex and extend your hip or knee.

What questions might a healthcare provider ask to diagnose iliotibial band syndrome?

Your healthcare provider will want to fully understand what you’re experiencing so that you receive the best care possible. Questions they might ask include:

• What are your symptoms?
• Where is the pain located?
• What does the pain feel like?
• How long have you had these symptoms?
• What medications do you take?
• How much pain are you in?
• Do you play any sports?
• Does the pain increase the longer you exercise?

How is iliotibial band syndrome treated?

There are some treatments for iliotibial band syndrome that you can do at home, while others require a healthcare provider. Common treatments include:

• Rest: Some experts recommend that you not exercise your hurt leg until your pain is gone and your iliotibial band syndrome has healed. Talk to your healthcare provider about how much rest and activity you should get.
• Pain medications: Examples of nonsteroidal anti-inflammatory drugs (NSAIDs) include Ibuprofen (Advil®, Motrin®) and Naproxen (Aleve®). Talk with your healthcare provider about correct dosages.
• Manual therapy: A physical therapist might teach you to use a foam roller to massage your body.
• Physical therapy: A physical therapist can teach you stretches, strengthening exercises and other treatments to help relieve your hip and knee pain. These treatments might help you lengthen your iliotibial band, decreasing the tension. A physical therapist can also show you how to best warm up before exercise and cool down afterward.
• Posture training: The way you hold your body when you go about your daily activities, playing sports or otherwise, might influence your iliotibial band syndrome.
• Steroid injections: Corticosteroids might reduce the inflammation in your iliotibial band.
• Surgery: Surgery for iliotibial band syndrome is rare. Your healthcare provider might recommend it if medications and physical therapy don’t work.

Does iliotibial band syndrome go away?

Your iliotibial band syndrome might heal after treatments such as rest, physical therapy and medications. The pain will likely increase if you don’t receive treatment. Discuss your options with your healthcare provider.

How can I reduce my risk of iliotibial band syndrome (ITBS)?

Preventing iliotibial band syndrome might be difficult if you’re an athlete such as a skier, cyclist or long-distance runner. But you might try changing some of the ways you do those activities to reduce your risk of ITBS. Examples include:

• Avoid running up or down a hill or any slanted surface.
• Make sure you have the right technique no matter what activity you do.
• Shift training intensity gradually. Slowly speed up when you’re bicycling instead of suddenly switching from slow to fast (or fast to slow).
• Slowly warm up and slowly cool down.
• Wear supportive shoes.

How long does it take to recover from iliotibial band syndrome (ITBS)?

With treatment, specifically nonsurgical treatment, about 50 to 90% of people with ITBS improve after about four to eight weeks. Some studies show that it happens within two to six weeks.

Can iliotibial band syndrome get worse?

Iliotibial band syndrome can worsen without treatment. Talk to your healthcare provider about psychical therapy, medications and other treatments.

What are the complications of this condition?

Iliotibial band syndrome can sometimes cause patellofemoral pain syndrome (PFPS). You might feel pain around and under your kneecap (patella) in addition to the knee and hip pain. Be sure to let your healthcare provider know if you have more symptoms. There are treatments for PFPS.

When can I return to my normal activities?

Once you're pain-free, you can slowly get back to your regular activities with your healthcare provider's permission. Make a plan with your provider. Together you can figure out what activities you can do and when you can safely do them.

When should I contact my healthcare provider?

Contact your healthcare provider if you have knee or hip pain that either doesn't get better after a few weeks or gets even worse.

What questions should I ask my healthcare provider about iliotibial band syndrome (ITBS)?

• What caused my iliotibial band syndrome?
• Do I need an ultrasound or MRI?
• Can you recommend a physical therapist?
• Will I need surgery?
• When can I get back to my normal activities?

A note from Cleveland Clinic

If you’re part of the 25% of adults who experience knee pain, you might have iliotibial band syndrome. When the tendon rubs against your hip or knee bones, it gets swollen and irritated, causing several symptoms. Athletes have an above-average chance at getting ITBS.

You might have to hop off your bike if you have iliotibial band syndrome. The pain might take you off the court, field or track. But, likely, you'll just have to take a break from your favorite sports, not give them up forever. ITBS is treatable. With your healthcare providers' help, you can recover from iliotibial band syndrome.