Overview

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in distance runners. Pain is attributed to compression and inflammation of a richly innervated fat pad deep to the distal iliotibial band rather than true friction over the epicondyle. Training errors, downhill running, weak hip abductors, and anatomical factors such as genu varum contribute.

Epidemiology

ITBS accounts for up to 12 percent of running-related injuries and is also common in cyclists. Peak incidence is between 20 and 40 years with no strong sex predilection; female runners with increased hip adduction during stance are at higher risk.

Symptoms

Sharp or burning lateral knee pain develops at a reproducible distance into activity and progressively shortens as the condition worsens. Pain is maximal at around 30 degrees of flexion and is aggravated by downhill running. Tenderness over the lateral femoral epicondyle and a positive Noble compression test are characteristic.

Imaging