Carlton J. Covey, MD, FAAFP Matthew K. Hawks, MD Nellis Family Medicine Residency Program, Nellis Air Force Base, Nev (Drs. Covey and Hawks); Uniformed Services University of the Health Sciences, Bethesda, Md (Dr. Covey) carlton.covey@us.af.mil
The authors reported no potential conflict of interest relevant to this article.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Air Force Medical Department or the US Air Force at large.
Iliotibial band syndrome (ITBS) is a common source of lateral knee pain, particularly in runners, cyclists, and endurance athletes.17-19,36,37 The exact pathophysiology behind this diagnosis is debatable, but the most accepted etiology is inflammation generated from micro trauma to the soft tissues with inadequate healing time, resulting in persistent inflammation. ITBS is often associated with excessive overall running mileage, a sudden increase in mileage, or an abrupt change in training.18,37
Patients with ITBS often complain of persistent nontraumatic knee pain that worsens with repetitive knee flexion.Diagnosis. Patients often complain of persistent nontraumatic lateral knee pain that worsens with repetitive knee flexion (eg, running or cycling).17-19,37 A physical exam will often reveal pain over the lateral femoral condyle and a positive Noble’s test (FIGURE 1). A positive Ober’s test (FIGURE 2) is suggestive of ITBS, as well. The sensitivity and specificity of these tests are not well established, but in patients performing repetitive knee flexion activities with subjective lateral knee pain, pain over the lateral femoral condyle and a positive Ober’s and/or Noble’s test suggest an ITBS diagnosis.18 Imaging is not indicated initially, but MRI should be used in refractory cases to rule out other etiologies.17,19
Treatment. First-line therapy for ITBS is conservative,17-19,36,37 often involving a combination of techniques such as refraining from the activity that triggers the pain, NSAIDs, activity modification to reduce the strain over the ITB, myofascial release via foam rollers, and physical therapy focused on stretching the iliotibial band, tensor fasciae latae, and gluteus medius while strengthening the gluteus medius and core muscles.17 No single program has been shown to be better than another.
Corticosteroid injections are second-line therapy and have been shown to improve pain compared with placebo up to 2 weeks post injection.17,19 When symptoms persist for more than 6 months despite conservative treatment, surgical intervention may be indicated.18,19 Patients who experience temporary pain relief with corticosteroid injections often respond best to surgery.36
