The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome
Iliotibial band (ITB) syndrome is a common overuse injury in runners and cyclists. It is regarded as a friction syndrome where the ITB rubs against (and 'rolls over') the lateral femoral epicondyle. Here, we re-evaluate the clinical anatomy of the region to challenge the view that the ITB moves antero-posteriorly over the epicondyle. Gross anatomical and microscopical studies were conducted on the distal portion of the ITB in 15 cadavers. This was complemented by magnetic resonance (MR) imaging of six asymptomatic volunteers and studies of two athletes with acute ITB syndrome. In all cadavers, the ITB was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. In no cadaver, volunteer or patient was a bursa seen. The MR scans showed that the ITB was compressed against the epicondyle at 30 degrees of knee flexion as a consequence of tibial internal rotation, but moved laterally in extension. MR signal changes in the patients with ITB syndrome were present in the region occupied by fat, deep to the ITB. The ITB is prevented from rolling over the epicondyle by its femoral anchorage and because it is a part of the fascia lata. We suggest that it creates the illusion of movement, because of changing tension in its anterior and posterior fibres during knee flexion. Thus, on anatomical grounds, ITB overuse injuries may be more likely to be associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.
- “An anatomic study of the iliotibial tract,” an article in Arthroscopy, 2007.
- “Effects of simulated vastus medialis strength variation on patellofemoral joint biomechanics in human cadaver knees,” an article in Journal of Rehabilitation Research & Development Vol, 2002.
- “Is iliotibial band syndrome really a friction syndrome?,” an article in Journal of Science & Medicine in Sport, 2007.
- “Iliotibial band syndrome: an examination of the evidence behind a number of treatment options,” an article in Scandinavian Journal of Medicine & Science in Sports, 2010.
- “Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?,” an article in J Ultrasound Med, 2013.
- “The source of fluid deep to the iliotibial band: documentation of a potential intra-articular source,” an article in PM & R: The Journal of Injury, Function, and Rehabilitation, 2014.
These four articles on PainScience.com cite Fairclough 2006 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 IT Band Stretching Does Not Work — Stretching the iliotibial band is a popular idea, but it’s very hard to do it right, and it’s probably not worth it
- PS IT Band Syndrome: Does the iliotibial band move after all? — An ultrasound study says it does, debunking my debunkery