Iliotibial band syndrome

The syndrome (Iliotibial band syndrome [ITB]) is caused by overuse related to repetitive movement of the knee in flexion and extension. ITB sydnrome can also develop after a contusion or bruise to the outer hip area. Iliotibial band syndrome may also occur with excess genu varus (bow-legs), cavus feet or heel varus. It is common among long distance runners and cyclists. 

The patient complains of diffuse lateral knee pain, outer hip pain and can experience an popping sensation in the hip or lower back. Numbness, tingling or weakness are typically not experienced as these symtoms would suggest a sciatica syndrome. The onset of the pain is coincides with increased running activity or physical activity. 

Physical examination: Diffuse lateral knee pain and swelling in the iliotibial band region. Careful evaluation needs to rule out lumbar disc pathology and signs of sciatica. Localized pain could also mean a burisitis of the greater trochanteric region.

Pathogenesis: The iliotibial band runs from ileum to tibia and helps stabilize the knee joint. Gluteus maximus and tensor fasciae latae muscles insert into this fibrous band and itself inserts into the lateral condyle of tibia. The pain usually occurs while the patient runs downhill. The iliotibial band impinges on the lateral condyle of the femur when the knee is flexed about 20-30 degree. This friction may result in tenderness over the condyle of femur. 

Therapy: The treatment consists of rest, stretching and medications including NSAID"s. If an aggressive stretching program doesn't relieve the pain,  local steroid injection may be helpful.