Iliotibial Band Syndrome (ITBS or ITBFS, for Iliotibial Band Friction Syndrome) is a common thigh injury generally associated with running. Additionally it can also be caused by biking, hiking or weight-lifting (especially squats). Iliotibial Band Syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front during the gait cycle. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed, or the band itself may suffer irritation.

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Iliotibial Band Syndrome is the result of poor training habits, equipment and anatomical abnormalities.

Training habits:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet “toed-in” to an excessive angle
• Running up and down stairs

Abnormalities in leg/feet anatomy:

• High or low arches
• Overpronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
  • Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.

Muscle Imbalance:

• Weak hip abductor muscles

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In some patients, ITBFS can be misdiagnosed as some other derangement of the knee, such as a lateral meniscal tear, lateral collateral ligament sprain, popliteal tendon strain, or lateral hamstring strain.

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