iliotibial band syndrome

This patient, with poorly localized lateral knee pain radiating to the thigh, shows typical features of iliotibial (IT) band syndrome.  IT band syndrome is a common overuse injury seen most frequently in inexperienced runners, especially those starting a new or more strenuous training regimen.  The exact pathophysiology is disputed, but it appears to arise from where the IT band passes over the lateral femoral condyle and may be due to compression of the intervening soft tissues.

The diagnosis of IT band syndrome is based primarily on history and physical examination findings.  The patient may demonstrate tenderness at the lateral femoral condyle, especially during flexion and extension of the knee.  Magnetic resonance imaging may show signal intensity abnormalities in soft tissues deep to the IT band, and sensitivity is good at experienced centers.  However, no studies have yet shown improved outcomes with magnetic resonance imaging and it is not recommended in uncomplicated cases (Choice C).

Management of IT band syndrome is primarily biomechanical.  Patients should be advised to reduce the intensity and duration of running sessions and begin a program of lower-extremity stretching and strengthening exercises.  A number of specific stretches are helpful and can be easily taught in only a few physical therapy sessions or physician office visits.  Refractory cases can be considered for corticosteroid injection or surgical intervention (rare).

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