Iliotibial band syndrome (ITBS) has known biomechanical factors with an unclear explanation based on only strength and flexibility deficits. Neuromuscular coordination has emerged as a likely reason for kinematic faults guiding research toward motor control. This article discusses ITBS in relation to muscle performance factors, fascial considerations, epidemiology, functional anatomy, strength deficits, kinematics, iliotibial strain and strain rate, and biomechanical considerations. Evidence-based exercise approaches are reviewed for ITBS, including related methods used to train the posterior hip muscles.
Key points
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Iliotibial band syndrome is the most common cause of lateral knee pain in runners, but needs further epidemiologic study to better understand differences among various types of runners.
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Contributing factors include strain and strain rate, kinematic deviations in the frontal and transverse plane, and weakness in the lateral and posterior hip musculature.
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The pathophysiology has 2 models, enthesopathy and compression versus impingement and friction.
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Neuromuscular coordination is a developing area of interest as a contributing factor and training method.
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Exercises are debated regarding the effect on changing running mechanics with attention to dosing and postures.
Introduction
Iliotibial band syndrome (ITBS) has been reported as the second most common running injury and most common reason for lateral knee pain in runners ( Fig. 1 ). In a prospective study of 400 female runners over 4 years in the University of Delaware community, the reported incidence of ITBS was 16%. Gender comparison has no definitive study, although Taunton and colleagues analyzed 2002 consecutive running injuries in a Vancouver running clinic, finding 63 cases of ITBS in 926 males and 105 cases of ITBS in 1076 females, indicating 6.8% male prevalence and 9.8% female prevalence. Interestingly no contributing factors were identified among the following: varus and valgus knee, pes planus, pes cavus, Q angle, and leg length. Tenforde and colleagues analyzed surveys for 442 female and 306 male runners aged 13 to 18 years old, finding lifetime self-reported prevalence of 7% female and 5% male. During an ultramarathon running event, Fallon reported 3 cases of ITBS in 29 runners, translating to an incidence of 10.3%. Epidemiologic understanding is limited by a lack of prospective studies measuring the incidence of ITBS. In addition, information is limited regarding incidence and prevalence of ITBS in various running populations: elite versus casual; and triathlon, 5 to 10 km, marathon, and ultramarathon. It is possible that these varying populations have different contributing factors.
