Is iliotibial band syndrome really a friction syndrome?
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Iliotibial band (ITB) syndrome is regarded as an overuse injury, common in runners and cyclists. It is believed to be associated with excessive friction between the tract and the lateral femoral epicondyle-friction which 'inflames' the tract or a bursa. This article highlights evidence which challenges these views. Basic anatomical principles of the ITB have been overlooked: (a) it is not a discrete structure, but a thickened part of the fascia lata which envelops the thigh, (b) it is connected to the linea aspera by an intermuscular septum and to the supracondylar region of the femur (including the epicondyle) by coarse, fibrous bands (which are not pathological adhesions) that are clearly visible by dissection or MRI and (c) a bursa is rarely present, but may be mistaken for the lateral recess of the knee. We would thus suggest that the ITB cannot create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee. The perception of movement of the ITB across the epicondyle is an illusion because of changing tension in its anterior and posterior fibres. Nevertheless, slight medial-lateral movement is possible and we propose that ITB syndrome is caused by increased compression of a highly vascularised and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle. Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed.
related content
- “The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome,” John Fairclough, Koji Hayashi, Hechmi Toumi, Kathleen Lyons, Graeme Bydder, Nicola Phillips, Thomas M Best, and Mike Benjamin, Journal of Anatomy, 2006.
- “Iliotibial band syndrome: an examination of the evidence behind a number of treatment options,” E C Falvey, R A Clark, A Franklyn-Miller, A L Bryant, C Briggs, and P R McCrory, Scandinavian Journal of Medicine & Science in Sports, 2010.
- “Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?,” Elena J Jelsing, Jonathan T Finnoff, Andrea L Cheville, Bruce A Levy, and Jay Smith, J Ultrasound Med, 2013.
- “The source of fluid deep to the iliotibial band: documentation of a potential intra-articular source,” Elena J Jelsing, Eugene Maida, Jonathan T Finnoff, and Jay Smith, PM & R: The Journal of Injury, Function, and Rehabilitation, 2014.
These five articles on PainScience.com cite Fairclough 2007 as a source:
- PS Save Yourself from IT Band Syndrome! — All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
- PS Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
- PS Is IT Band Tendinitis Really a Tendinitis? — Recent research has clearly shown that the IT band itself is not the anatomy that gets inflamed, which has significant implications for treatment
- PS Patellofemoral Tracking Syndrome — The beating heart of the conventional wisdom about patellofemoral pain is mostly nonsense
- PS Does the IT Band Move After All? — An ultrasound study says it does, debunking my debunkery
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.