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Iliotibial Band Friction Syndrome

Physical Therapy Management and Treatment

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Updated October 12, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Iliotibial Band Friction Syndrome (ITBS) is a condition that occurs when abnormal rubbing or friction occurs at the side of the knee where the iliotibial band (IT band) crosses. The abnormal rubbing causes the IT band to become inflamed and can cause knee pain. Occasionally the pain can be felt up and down the outside of the affected thigh and may even be felt as hip pain.

What Is the Iliotibial Band?

The iliotibial band is a thick band of tissue that runs on the outer part of the thigh between the hip and the knee. As it crosses the knee it passes over the lateral epicondyle of the femur (thigh bone). It attaches to the front of the shin bone, or tibia. There is a bursa beneath the IT band that helps the band glide smoothly when you bend and straighten your knee.

What Are the Symptoms of ITBS?

Common symptoms of ITBS are burning pain in the outside part of the knee or pain over the outer part of the thigh or hip. The burning pain typically occurs during exercises that require repetitive bending and straightening like cycling or running.

What Causes ITBS?

There are many causes of ITBS. Occasionally, tight muscles around the hip and the knee can cause abnormal friction between the IT band and the bones of the hip or knee. The IT band may be subjected to rubbing forces as it passes over bony prominences near the knee. Weakness in muscles around the hip and thigh may also contribute to ITBS. Improper foot position, such as over pronation while running, may also be a source of ITBS. Since the causes of ITBS are multifactorial, a focused evaluation by your doctor and physical therapist can help lead to proper management of the problem.

Physical Therapy Evaluation for ITBS

If you are experiencing pain in the outer part of the hip or knee, you may have ITBS. Sometimes the symptoms of ITBS are short lived and can go away with rest. If your pain is persistent or interferes with normal activity, you should see your physician to help you initiate the proper treatment. A physical therapy evaluation may be necessary to help discover the causes of the problem and lead to proper management.

The physical therapy evaluation for ITBS usually starts with a focused history. Be prepared to tell your physical therapist when your symptoms started and how specific activities affect your symptoms. The history helps your physical therapist choose where to focus the evaluation. Tests and measures may include:

  • Muscle flexibility. Muscles of the hips and legs are usually assessed to see if tightness may be causing abnormal friction between the IT band and the bones of the knee.

  • Muscle strength. If you have ITBS, muscle weakness may be present in the thigh, hips or legs. This weakness may lead to an abnormal position of the knee during activities like running and cycling, causing rubbing of the IT band against the bones of the knee.

  • Range of motion. Range of motion measurements may be taken at the knee, hip or ankle to assess if decreased mobility of those joints is contributing to your problem.

  • Special tests. The Noble Compression Test is a special test for ITBS. During this test, the IT band over the outside part of the knee is pressed while the knee is flexed and extended. A positive test yields intense burning over the IT band when the knee is almost fully straightened. Ober's test is a special test to measure the flexibility of your IT band. Your physical therapist may perform other tests to ensure that your knee ligaments or meniscus are not causing your problem.

  • Gait evaluation. A gait evaluation may be performed to assess the movement and position of your hips, knees and feet as you walk or run. The position of your foot may also be assessed to see if there is over pronation, a common foot alignment problem, may be causing your symptoms.

Treatment for ITBS

Acute Phase. The first three to five days of pain in the knee or hip are considered the acute phase of injury to the IT band. During this time, avoidance of the activity that caused the pain is recommended. Ice to the affected area can help control the inflammation. Ice should be applied for 15 to 20 minutes several times per day during the acute phase.

Subacute Phase. After five to seven days of relative rest and icing the injured tissue, gentle motion can be started to help ensure proper healing of the IT band. During this time stretching of the IT band and the supporting muscles can be started. Simple knee strengthening and hip strengthening exercises may be started if indicated by your doctor or physical therapist.

Return to Activity. After a few weeks of gentle strengthening and stretching, more aggressive exercises can be performed to ensure that the IT band is able to tolerate the forces that it may encounter during your athletic activity. Advanced hip strengthening exercises can be started to ensure that the hip and abdominal muscles are providing proper support. If foot pronation is a problem orthotics or inserts may be tried in the shoes to correct the problem.

Iliotibial band friction syndrome usually lasts about six to eight weeks, depending on the severity of the injury. If your symptoms are persistent, a follow up visit with your physician may be necessary to see if more invasive treatment options, like cortisone injections, are warranted.

Pain on the outside of your knee or hip can limit your ability to walk, run, cycle, or participate fully in normal recreation. By starting treatment early and by following the advice of your physical therapist and doctor, you may be able to abolish the pain from ITBS and return to normal activity quickly and safely.

Hertling, D. (2006). Management of common musculoskeletal disorders. (4th ed.). Philadelphia: Lippincott Williams & Wilkins Safran, M., Stone, D., & Zachazewski, J. (2003). Instructions for sports medicine patients. Philadelphia: Saunders.

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