Iliotibial band friction syndrome (ITBS) presents as lateral knee pain and is exacerbated by sporting activity, particularly running and cycling. It is commonly seen in endurance athletes and military recruits.
Traditionally, this syndrome was believed to be the result of friction between the iliotibial band (ITB) and the lateral femoral epicondyle. However, recent anatomical studies reporting an absence of bursal tissue between the lateral femoral epicondyle and ITB have cast doubt over this belief. It is possible that a layer of local fatty tissue or compression of the underlying bone could be the source of pain. If the ITB were thought more as a lateral thickening of the circumferential fascia surrounding the thigh rather than a discrete band then the current concept of compression irritation rather than friction may be better understood.
Rehabilitation of ITBS has traditionally focussed on stretching and activity modification. However, improving the strength and activation patterns of the hip muscles may prevent recurrence. The tensor fascia lata and gluteus maximus muscles both attach proximally to the ITB, and contribute to stabilisation around the hip joint. Indeed studies have correlated hip muscle weakness, particularly the external rotators, with ITBFS.
For more information on ITBS refer to Chapter 34 in the new edition of the CSM textbook which acknowledges and discusses these advancements into the understanding of the syndrome. Several management options are presented.