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IT Band Syndrome

What is IT Band Syndrome?

The iliotibial band (IT band) is a tendon that extends from the top of the pelvis to the knee on the outside of each leg. This tendon can become inflamed and swollen if it becomes too tight and begins to rub against your hip or knee bones.

If the IT band becomes injured due to overuse, improper stretching, or a structural abnormality, it can cause pain at the hip or knee. This is known as IT band syndrome or ITBS. IT band syndrome can be present in one leg or both legs, in which case it is known as bilateral IT band syndrome.

Professional and recreational athletes have the highest risk of an overuse injury to the IT band, especially if they perform activities with repetitive leg motions. Studies report that ITBS affects up to 14% of the running population. Females are more likely to have ITBS than males. Other athletes who are prone to IT band syndrome include basketball players, cyclists, field hockey players, soccer players, skiers, and rowers. However, IT band syndrome can affect workers and non-athletes just the same if they perform repetitive activates of daily living such as prolonged walking, kneeling, bending, or sitting.

Inflammation of the iliotibial band occurs when it is stretched too tight, and excessively rubs against the femur (thighbone). This repetitive contact can cause pain and swelling within the iliotibial bursa between the bone and tendon. While ITBS is commonly thought to be caused by the friction of the IT band rubbing against bone, some studies suggest that the pain is due to the iliotibial band not transferring loads properly.

While the etiology of IT band syndrome involves several causes, individual and training factors can contribute to a tight iliotibial band. Some people are born with a tighter iliotibial band, and variations in anatomy can make people more prone to rotation or compensatory movement.

Possible anatomic causes for a tight IT band include:

  • Foot hyperpronation: Foot pronation (the foot rolls inward when walking) causes internal rotation of the tibia and femur, leading to excessive strain at the knee. This internal rotation causes excessive lengthening and stretch to the IT band, which can manifest as pain.
  • Internal tibial torsion: The tibia (shin bone) is slightly twisted or rotated, causing the foot to turn in which creates excessive tension and pain to the iliotibial band.
  • Leg length discrepancy: The asynchronous placement of the foot while walking or running due to uneven leg lengths results in pelvic asymmetry, and problems in the IT band arise from compensatory movement strategies.
  • Knee arthritis: Arthritis in your knees can lead to genu varum (bowlegs), a condition where your knees stay apart even when standing up straight, causing excessive tension to the IT band.
  • Muscle strength imbalances: When a muscle on one side of your body is smaller or weaker than the corresponding muscle on the other side, it can result in compensatory movement strategies to complete sports or daily living related tasks, which can lead to inflammation in the IT band.
  • Weak hip abductor: Iliotibial band tightness may be a compensatory mechanism in individuals with hip abductor muscle weakness, which in turn can cause constant tension and pain to the IT band.

  • Not stretching enough before exercise or cooling down too quickly after a workout.
  • Overtraining or improper sports technique.
  • Lack of sleep. If you do not give yourself enough time to rest and recover between trainings, you may overload your system and use faulty movement patterns.
  • Running downhill or on an uneven surface. This can cause repetitive stress on your IT band.
  • Wearing worn out shoes. A good rule of thumb is to replace your running shoes every 300 to 500 miles.

IT band syndrome is the number one cause of lateral knee pain (the outside of the knee) in runners, and the number two cause for knee pain. A person might also experience lateral sided hip pain, or have clicking, popping, or snapping sensations in their hip. There may be warmth and redness on the outside of the hip or knee due to inflammation.

Someone suffering from ITBS may at first notice an aching and burning sensation after exercise. As the condition worsens, the pain will become sharper.

The experts at LALL Orthopedics + can usually diagnose IT band syndrome based on a discussion of your medical history, current symptoms, and a comprehensive physical examination. The physical examination will include a thorough evaluation of your hip and knee, with an assessment of your gait pattern and tests to measure your range of motion and strength.

Typically, no additional testing is required to diagnose IT band syndrome. However, if the diagnosis is unclear, our team of experts may order an MRI or X-ray to rule out other possible causes of pain.

Conservative treatment involves rest, massage, cross training, anti-inflammatory drugs, cortisone injections, physical therapy, posture training, and cutting-edge regenerative medicine treatment with platelet-rich plasma (PRP). Surgical management is IT Band release and is rarely indicted.

If you have symptoms consistent with IT band syndrome, schedule a hip consultation with LALL Orthopedics +. LALL Orthopedics + is led by renowned hip surgeon Dr. Ajay C. Lall. Dr. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon. LALL Orthopedics + specializes in the treatment of IT band syndrome.

LALL Orthopedics + has offices in Paramus, NJ, Philadelphia, PA and Belvidere, IL. Our team regularly sees patients from Bergen County, Hackensack, and Morristown, NJ.

At a Glance

Ajay C. Lall, MD, MS, FAAOS

  • Board Certified – Orthopedic Surgery
  • Triple Fellowship Trained
  • Performs over 750 Surgeries Per Year
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