Iliotibial band (ITB) syndrome

Iliotibial band (ITB) syndrome is a condition where pain is felt in the outer aspect of the lower thigh, just above the knee, on physical activities.

The ITB is a strong band of connective tissue which runs from the outer aspect of the pelvis to the outer aspect of the tibia bone just below the knee joint.

Through its attachment to many of the gluteal muscles and the tensor fascia lata (TFL) muscle at the pelvis, the ITB generates significant tension during sporting activities involving repeated flexion and extension of the hip and knee such as running and cycling.

ITB syndrome arises if there is weakness and lack of flexibility in the muscles of the hip and knee. Excessive tension through the ITB causes friction in the outer lower thigh with associated pain.

Normally ITB syndrome is the result of sharp increases in training intensity without adequate rest between training sessions.

Pain while jogging, cycling, during squatting movements or ascending/descending stairs are often aggravating activities. The pain will normally be felt as a well localised sharp pain on the outer aspect of the lower thigh.

Often symptoms are not felt initially but come on after running a short distance and are relieved by rest.

If symptoms are severe there may be a clicking when the knee is flexed and extended as the ITB flicks over the outer knee.

ITB syndrome can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is significant tenderness along the ITB and the outer aspect of the knee over the area which the ITB passes. Sometimes a clicking may be felt at the site of pain.

X-rays and scans are not routinely required.