Iliotibial Band Syndrome

Warmth and redness around the knee

What is iliotibial band syndrome?

The iliotibial band, sometimes called Maissiat's band or the IT band, is a strong thick band of fibrous tissue that runs down the thigh from the hip to the top of the shins and inserts at the knee. It is a tendon which provides stability to the pelvis allowing the extension abduction and rotation of the hip. It is also key in providing mobility of the sides of one’s knee and protecting the outer thigh region. 

Iliotibial band syndrome (ITBS) is a condition that occurs when the tendon becomes inflamed from friction at the lateral femoral condyle (LFE) and compression of soft tissues at the region. It is the result of overuse of the lateral aspect of the knee (outer region) and can cause subsequent irritation and swelling. IIliotibial band syndrome is a common injury among athletes and encompasses over 22% of lower extremity injuries. It is also the source of many lateral knee pains and can occur in one or both legs (bilateral iliotibial band syndrome). 

iliotibial band syndrome
Iliotibial band syndrome is an injury caused by inflammation of the iliotibial band tract.

Iliotibial band syndrome is categorised by the level of pain and extent of obstruction faced when performing activities. 

These grades are: 

  • Grade 1: pain on the outer part of the knee after conducting an exercise. Pain is described as a “generalised pain” which subsides within 24 hours after rest or inactivity. 
  • Grade 2: “burning/radiating pain” is felt during or when completing an exercise but does not affect the general performance of an activity.
  • Grade 3: pain is significant and inhibits the performance of an exercise. One may feel restricted in terms of mobility and clearly observe a reduction in efficiency.
  • Grade 4: pain starts to impact day-to-day activities. One may undergo extreme discomfort and former peak performance become unattainable.
  • Grade 5: pain significantly disrupts exercises and day-to-day living. At this stage, one may observe a sharp decline in quality of life. 

What causes iliotibial band syndrome?

Iliotibial band syndrome is fundamentally caused by irritation and swelling from rubbing against hip or knee bones, subsequently resulting in inflammation. 

There are a few factors that could lead to the occurrence of iliotibial band syndrome, these are:

  • Congenital anatomical features: certain anatomical conditions that some individuals are born with may predispose them to iliotibial band syndrome. These include foot pronation, varus knee, prominent lateral condyle, a tight iliotibial band, leg length discrepancy, and weak hip abductors.
  • Training errors: wearing improper footwear, cooling down too quickly, or insufficient warm-ups may lead to iliotibial band syndrome. 
  • Abrupt motion: certain movements such as running downhill too quickly or swerving at turns abruptly could injure the iliotibial band tract. 
Varus knee
Congenital features such as varus knee or bowlegs predisposes one to iliotibial band syndrome.

What are the symptoms of iliotibial band syndrome?

Iliotibial band syndrome is often accompanied by the following symptoms:

  • Knee and hip pain
  • Clicking sensations (a snap, pop, or click) on the lateral outer aspect of the knee
  • Crepitus (crackling) in the hip or knee
  • Warmth and redness 
red knee
Redness around the knee is a symptom of iliotibial band syndrome.
If you notice any of the symptoms, make an appointment with an orthopaedic specialist to get an accurate diagnosis and treatment.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Is iliotibial band syndrome painful?

Yes, the condition is generally accompanied by pain.

However, one may be unconscious of the pain if the injury is categorised as first or second grade iliotibial band syndrome. It may mistakenly be dismissed as muscle soreness from training. The ability to identify pain may also be hindered if one generally has high tolerance towards pain. 

Who is at risk of iliotibial band syndrome in Singapore?

There are some clearly defined risk factors for iliotibial band syndrome, these are:

  • Existing health condition: individuals with arthritis in the knee tend to be susceptible to iliotibial band syndrome.
  • Gender: women are more prone to iliotibial band syndrome potentially attributed to their wider hips and increased Q angle (the angle between the thigh bone and the kneecap). 
  • Athletes: iliotibial band syndrome is a common lower extremity injury amongst runners. Cyclists, skiers, and football players also tend to be prone to iliotibial band syndrome potentially attributed to the long-distance exertion nature of these sports. 

How is iliotibial band syndrome diagnosed?

Iliotibial band syndrome can be diagnosed in the following ways: 

  • Physical examination and medical history: inform your orthopaedist of the potential activities that may have led to an injury such as trauma, exercise, or sports. Physically the area of injury will be examined and motion tests such as the Ober test and Noble test are sufficient in diagnosing iliotibial band syndrome.
  • Imaging tests: magnetic resonance imaging (MRI) may be required to rule out conditions such as meniscus or LCL injuries. If necessary, an ultrasound may be conducted to obtain a clear visualisation of soft-tissue swelling, collection of fluid, inflammation of the bursa (bursitis), or the thickening of the iliotibial band. 

What are the treatment options for iliotibial band syndrome in Singapore?

Typically conservative treatments would suffice for recovery as iliotibial band syndrome is a self-limiting condition (capable of healing on its own).

Treatment methods may be employed to increase the speed of recovery, these treatment options are: 

  • Medications: given that iliotibial band syndrome is primarily an inflammatory condition, non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment to reduce inflammation and manage pain.
  • Injections: corticosteroid injections may be used to manage pain and relieve symptoms associated with iliotibial band syndrome. 
  • Rest: rest from physical activity is usually prescribed until symptoms reduce, this may range between 2-4 weeks. 
  • Physiotherapy: physiotherapy is fundamental in the treatment of iliotibial band syndrome. Your orthopaedist may concurrently conduct them during the rest period or prescribe them after observing complete inactivity. The physiotherapy employed would depend on the severity of the condition and the specifics of the injury that has occurred. 
  • Arthroscopic surgery: surgery is often the last line of treatment deployed. Surgery is an option for athletes who are in a time crunch to return to sports activities or where the condition has exacerbated and is causing unmanageable interferences in quality of life. Surgery would involve the removal of a part of the iliotibial band tract which is causing friction or inflamed bursa and cysts if any are identified. 
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For emergency appointment, please call or Whatsapp us at (65) 8909 8877. We will arrange for a limousine to send you to our clinic.
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