ITBs

Iliotibial band syndrome (ITBS) is a common musculoskeletal condition that causes lateral knee or thigh pain, often linked to overuse. It most frequently affects runners and cyclists, especially those who increase training volume rapidly, run downhill, or have biomechanical factors such as leg length differences, overpronation, or weak hip abductors. The pain results from repetitive friction between the iliotibial band and the lateral femoral epicondyle during knee bending.

Symptoms typically include a sharp or aching ache on the outer side of the knee, which may worsen with continued activity, especially downhill running or cycling. Some individuals notice a snapping sensation over the outside of the knee. Symptoms may ease with rest and return during activity, leading to a cycle of pain with training.

Diagnosis is usually clinical, based on history and physical examination. Special tests such as the Noble compression test or the Ober test may reproduce pain or stiffness. Imaging is not routinely required but can be used to exclude other knee injuries; MRI can show thickening of the IT band or local inflammation, though findings are not specific.

Treatment focuses on symptom relief and activity modification. Initial care includes rest from aggravating activities, ice, and nonsteroidal anti-inflammatory drugs as appropriate. Physical therapy is central, emphasizing hip abductor and core strengthening, IT band stretching, and gradual return to activity with attention to running mechanics, footwear, and training volume. Injections and, rarely, surgical release are reserved for persistent cases after conservative measures have failed.

Prognosis is generally favorable with adherence to rehabilitation. Prevention strategies include gradual training progression, cross-training, strengthening of hip stabilizers, adequate warm-up, and addressing biomechanical factors.