Iliotibial Band Friction Syndrome

Repetitive activity can also lead to irritation of the soft tissues, such as the iliotibial band friction syndrome, which is common in runners. The iliotibial band is a thick fibrous tissue band that runs along the lateral aspect of the thigh and inserts at Gerdy tubercle on the anterolateral aspect of the proximal tibia. It has small attachments to the lateral patellar retinaculum and to the biceps femoris. As the knee moves from full extension to flexion, the iliotibial band shifts from a position anterior to the lateral femoral epicondyle to a position posterior to the epicondyle (Fig. 4 – 60). The transition occurs at about 30 degrees of knee flexion. The repetitive flexion and extension of the knee in running can lead to irritation of the iliotibial band as it passes back and forth over the lateral femoral epicondyle. Subsequently, the surrounding tissues and bursa become inflamed and painful.

History and Examination
Patients typically complain of a gradual onset of pain, tightness, or burning at the lateral aspect of the knee that develops during the course of a run. Symptoms usually resolve with rest. Examination reveals tenderness and possibly localized swelling at the lateral femoral epicondyle or at Gerdy’s tubercle, and when the knee is put through ROM, pain, snapping, popping, or crepitation may be felt as the iliotibial band crosses the epicondyle. Iliotibial band contracture is associated with the presence of symptoms and this can be evaluated by the Ober test (see p. 325).

Predisposing Factors
Factors that predispose runners to iliotibial band friction syndrome include inexperience, a recent increase in distance, and running on a track. Other potential etiologies include leg-length discrepancies, hyperpronation of the foot, and running repetitively in one direction on a pitched surface.

Treatment of Iliotibial Band Friction Syndrome
The basic progression of treatment is early reduction of the acute inflammation, followed by stretching of the iliotibial band and strengthening of the hip abductors to alleviate soft tissue contracture, and finally, education in proper running techniques and institution of an appropriate running program to prevent recurrence (see following rehabilitation protocol).