■ ■ ■ Description

The iliotibial band is the tendon attachment of hip muscles into the upper leg (tibia) just below the knee to the outer side of the front of the leg. Where the tendon passes the knee (lateral femoral condyle) there is a bursa sac between the bone and the tendon. This tendon moves over a bony bump at the outer knee as it passes in front and behind it. The bursa functions like a water balloon to reduce friction and wear of the tendon against the bony bump. In this condition, overuse causes excessive fric- tion at this bump, resulting in inflammation and pain of the bursa (bursitis), tendon (tendinitis), or both.

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■ ■ ■ Common Signs and Symptoms

• Pain, tenderness, swelling, warmth, or redness over the iliotibial band at the outer knee (above the joint); may travel

       up or down the thigh or leg

• Initially, pain at the beginning of an exercise that lessens once warmed up; eventually, pain throughout the activity, worsening as the activity continues; may cause the athlete to stop in the middle of training or competing

• Pain that is worse when running down hills or stairs, on banked tracks, or next to the curb on the street

• Pain that is felt most when the foot of the affected leg hits the ground

• Possibly, crepitation (a crackling sound) when the tendon or bursa is moved or touched

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■ ■ ■ Causes

Iliotibial band syndrome is caused by excessive friction of the iliotibial band and the underlying bursa due to repetitive knee-bending activities. This is an overuse injury, although direct trauma to the outer knee may cause the bursa to get inflamed. Often the deceleration of running down hills may lead to the excessive friction.

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■ ■ ■ Risk Increases With

• Sports with repetitive knee-bending activities, such as distance running and cycling

• Incorrect training techniques, including sudden changes in the amount, frequency, or intensity of the training, as well

       as inadequate rest between workouts

• Poor physical conditioning (strength and flexibility), especially tight iliotibial band

• Inadequate warm-up before practice or play

• Bow legs

• Arthritis of the knee

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning:

  • Knee and thigh flexibility (especially iliotibial band)

  • Muscle strength and endurance

  • Cardiovascular fitness

• Use proper training technique, including reducing mileage run, shortening stride, and avoiding running on hills and banked surfaces.

• Wear arch supports (orthotics) if you have flat feet.

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■ ■ ■ Expected Outcome

This condition is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.

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■ ■ ■ Possible Complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Chronically inflamed tendon and bursa, causing persistent pain with activity that may progress to constant pain

• Recurrence of symptoms if activity is resumed too soon, with overuse, with a direct blow, or with poor training technique

• Inability to complete training or competition

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises (particularly the iliotibial band), and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. An orthotic (arch support) for those with flat feet or a wedge for the shoe for those with tight iliotibial bands may be prescribed to reduce friction to the bursa. A knee sleeve or bandage may help keep the tendon and bursa warm during activity and reduce some symptoms. Training techniques can be altered by lessening the amount of the training activity, changing the stride length, avoiding running on hills or stairs, changing the direction you run on a circular or banked track, or changing the side of the road you run on if you run next to the curb in the same direction all the time. Cyclists may need to change the seat height or foot position on their bicycles. An injection of cortisone into the bursa may be recommended. Surgery to remove the inflamed bursa and part of the scarred or inflamed iliotibial band is usually only considered after at least 6 months of conservative treatment.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers are usually not prescribed for this condition, although your physician will determine this. Use only as directed and only as much as you need.

• Cortisone injections can reduce inflammation.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after any activity which aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 to 4 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)