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Iliotibial band (IT) syndrome is a common cause of pain on the outside or lateral side of the knee. I see it commonly in my patients who are runners and cyclists or an athletes doing a sport where the knee undergoes repetitive flexion and extension.
The IT band is a dense fibrous band of connective tissue that runs all the way from the lateral side of the pelvis down to the lateral side of the knee. The IT band acts to either extend or flex the knee depending on what angle the knee is positioned in, while also providing some added stability to the knee.
With sports such as cycling or running where there is repetitive flexion and extension of the knee, there can be friction between the IT band and a bony bump off of the side of the knee called the lateral epicondyle. This friction phenomenon causes inflammation of the IT band at this location. When the knee is at about 30 degrees of flexion, the impingement of the IT band on the lateral epicondyle is most severe, and not surprisingly, this is the position the knee is usually in when most runners experience sharp pain. In a runner, the knee typically comes into this position just after their foot contacts the ground. Cyclists typically spend less time in this impingement zone than do runners. Thus, this condition is more common in runners than cyclists.
As for risk factors, runners who run uphill, downhill, and at a slower pace spend more time in this impingement zone and can therefore be more symptomatic. Excessive stride length and running longer distances can also make the condition worse. Someone who is bowlegged or flat footed or has weak hip abductors is also more prone to develop this condition as all of this leads to increased resting tension in the IT band.
In the office, patients with IT band tendonitis have pain over the lateral side of their knee just above their joint line. Oftentimes, I can feel some crepitus or “creaking” as I palpate this area and move the knee. Usually there is a significant contracture of the IT band on physical exam. The quadriceps is often tight as well.
In the office, I obtain a radiograph of the knee to be sure there is no knee arthritis or other conditions that could be contributing to the lateral sided knee pain. An MRI is usually unnecessary but in cases where I have them to review, they typically show thickening of the IT band with a fluid collection deep to it.
As for treatment, I am a big fan of an IT band foam roller. This is a good way of stretching out and mobilizing the IT band. Rolling out the gluteal muscles is also helpful. I also send patients to physical therapy. Runners are naturally more dominant in their quadriceps and hip flexor musculature, so it is critical when not running to have these athletes strengthen the opposing muscle groups, namely the gluteal and hamstring muscles and also core musculature. Occasionally, I will inject a steroid medication around the IT band for recalcitrant cases or to get an athlete through a big upcoming event such as a marathon. Utilizing a running coach for a few sessions can also be helpful. In some refractory cases, surgery may be required to eliminate the condition.
Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team and Chief of Surgery at Vail Valley Medical Center. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit www.vsortho.com.