ITB friction syndrome

Section 1

The contention exists within the title….!

However, despite this, the diagnosis of Iliotibial band friction syndrome (ITBFS) is characterised by pain felt over the outside (lateral) aspect of the knee. It is closely associated with activity, often being aggravated by activities that involve repeated episodes of single leg stance, or cyclical loading whilst bending/straightening the knee (sound familiar…running!).

Section 2


“Iliotibial band friction syndrome (ITBFS) was first specifically described by Renne (1975) as a pain felt on the lateral aspect of the knee with lower limb activities such as running and cycling. Following an increase in the popularity of running and other endurance multi-disciplinary sports, since the 1980s, ITBFS has become more common (Anderson, 1991; Kirk et al., 2000). The overall incidence of ITBFS can range from between 1.6% and 52% depending on which population you examine (Kirk et al., 2000; Brosseau et al., 2004). However, it is generally accepted that ITBFS is the most common running injury of the lateral knee, and has an incidence of between 1.6% and 12% (Orava, 1978; McNicol et al., 1981; Messier et al., 1995; Fredericson et al., 2000; Taunton et al., 2002)……. ITBFS is uncommon in the inactive population (Orava, 1978).” Ellis et al. Iliotibial band friction syndrome—A systematic review, Manual Therapy, August 2007

This opening statement is a great example of how prevalent this problem is, but also how varied its prevalence is!! Even within running populations, this can range from 1.6% to 12% of runners!

So identifying who and why certain people are at risk would really help with specific interventions to reduce its incidence within certain sub-groups.

Studies such as this Hip Abductor Weakness in ITBFS have identified certain characteristics within people who already have pain, but prospective studies (those looking before the injury occurs) are key to our understanding of prevention.

Section 3

Noehren et al 2007 looked at this very problem prospectively. They found that

The iliotibial band syndrome group exhibited significantly greater hip adduction and knee internal rotation. However, rearfoot eversion and knee flexion were similar between groups. There were no differences in moments between groups.

The development of iliotibial band syndrome appears to be related to increased peak hip adduction and knee internal rotation. These combined motions may increase iliotibial band strain causing it to compress against the lateral femoral condyle. These data suggest that treatment interventions should focus on controlling these secondary plane movements through strengthening, stretching and neuromuscular re-education.

The truly interesting thing about these findings, is that the muscles that helps to control these movements of the hip and knee are the hip abductors, shown retrospectively to be weak within a population with ITBFS pain. These findings help to iron out, in part, some of the question marks about case and effect. It is likely that in this situation hip abductor weakness is both causative and effective of ITBFS…..This is yet another reason behind why us physios like to harp on so much about glutes!!

The story didn’t stop there, Noehren et al 2008, took these findings on a level, and wanted to understand what the result of these movement patterns where, and the influence it had on the strain rate and loading duration at the point of friction (between the ITB and the lateral femoral epicondyle (LFE)).

They found and concluded this

The results indicated that the iliotibial band syndrome subjects exhibited greater strain throughout the support period, but particularly at midsupport compared to the control group. Strain rate was significantly greater in the iliotibial band syndrome group compared to the control group and was greater in the involved limb of the iliotibial band syndrome group compared to their contralateral limb. However, there were no differences in the duration of impingement between the groups.

This study indicates that a major factor in the development of iliotibial band syndrome is strain rate. Therefore, we suggest that strain rate, rather than the magnitude of strain, may be a causative factor in developing iliotibial band syndrome. The effect size (>0.5) indicated that strain rate may be biologically significant in the etiology of iliotibial band syndrome.

It still supports those gluteal exercises I’m afraid, but possibly highlights the importance of training them to switch on quickly, not just forcefully…..lets pick this up in the exercise section.

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