Figure 1. Coronal MRI of the knee.
A 22-year-old man presents with lateral knee pain that has been present for the last month. He is an avid runner and usually runs 4 to 5 miles every few days. The patient notes that the lateral knee pain has started to increase and he is now unable to run more than a mile. Radiographs of the right knee are unremarkable. Coronal magnetic resonance imaging (MRI; Figure 1) shows mild inflammation of the iliotibial band bursa at the lateral knee.
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The iliotibial (IT) band originates from the level of the greater trochanter as a continuation of the tensor fasciae latae and gluteus muscles. The dense fibrous tissue then travels distally along the lateral thigh where it inserts at Gerdy’s tubercle at the anterolateral aspect of the proximal tibia. Iliotibial band syndrome (ITBS) is very common in runners as repetitive knee flexion can cause friction as the IT band slides over the lateral femoral epicondyle.1,2 Downhill running and running in the same direction continuously on a track can increase the likelihood of developing ITBS.1
The classic presentation of ITBS includes lateral knee pain in a runner that increases proportionally with frequency and intensity of running. Pain to palpation is often over the IT band distally or around 3 cm proximal to the lateral joint line.1
The Ober test is the most common provocative test performed to determine IT band tightness. The test involves lying the patient on the unaffected side, then abducting and extending the affected leg, followed by slowly lowering the leg down to the table. The test is positive if the leg stays in the air and must be forced down to the table.1,2
The mainstay of treatment is nonoperative with a period of rest, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. A local corticosteroid injection can be beneficial for diagnostic and therapeutic purposes. Physical therapy can work on stretching the IT band and running mechanics.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants
1. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19(12):728-736. doi:10.5435/00124635-201112000-00003
2. Fredericson M, Wolf C. Iliotibial band syndrome in runners; innovations in treatment. Sports Med. 2005;35(5):451-459. doi:10.2165/00007256-200535050-00006