Iliotibial band syndrome (ITB pain)

Your iliotibial band is a thick band of connective tissue (tendon) that runs along the outside of your thigh from your hip bones (pelvis) to the top of your shinbones (tibia). This band helps keep your hip and knee stable and allows you to move your knee joint and bend and extend your leg. Iliotibial band syndrome occurs due to friction between your iliotibial band and hip or knee bones. This leads to inflammation in the fluid-filled sacs (bursae), compression of the fat pads and connective tissue and pain.

The cost of private iliotibial band syndrome will depend on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

The main symptom of iliotibial band syndrome is pain on the outside of your knee. Iliotibial band pain can be sharp, aching or burning. It can affect one or both knees and may radiate to your thighs. In the early stages of the condition, pain usually starts soon after starting exercise but may start earlier and continue after you have finished exercising as your condition worsens. Eventually, you may feel pain all the time, even at rest.

Other symptoms of iliotibial band syndrome may include:

• Hip pain
• A clicking or snapping sensation in your knee joint
• Heat, redness and swelling around your knee joint

Iliotibial band syndrome occurs when there is friction between the iliotibial band and the bone, leading to irritation, inflammation, and pain.

Common risk factors that can lead to iliotibial band syndrome include:

• Engaging in aggravating activities where you repeatedly bend and extend your knee, such as running, cycling, hiking, and climbing stairs
• Starting a new training regimen or suddenly increasing your activity level
• Not warming up or cooling down properly before and after exercising
• Wearing improper running shoes
• Running on uneven, rough or sloping surfaces 
• Tightness or weakness in the muscles around your buttocks, hips, and knees 
• Conditions you are born with, where your legs are not aligned (in the correct position), such as overpronation (when your feet roll inwards) or differing leg length

At your first consultation, you will be seen by a consultant orthopaedic surgeon, a doctor specialising in conditions affecting the bones, muscles, joints and soft tissues. Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care.

At your appointment, your consultant will ask you about your symptoms, medical history and general health. They will perform a thorough physical examination and may order tests or scans to confirm or rule out a diagnosis. During your appointment, your consultant will spend time getting to know you and encourage you to ask any questions you may have. At Circle Health Group, we want you to be as well-informed and comfortable as possible during your time with us, so please discuss any questions or concerns with your consultant during your appointment.

It may help to write down any questions before your appointment, so you don’t forget them. You may want to ask about:

• Your consultant’s qualifications and experience
• What could be the cause of your iliotibial band syndrome
• What lifestyle changes you can make to reduce your symptoms and prevent them from coming back
• Any exercises you can do to ease your symptoms
• Any activities you should limit or avoid 
• What treatments are available 
• If surgery is recommended, what happens during the procedure, the type of anaesthetic that will be used, any possible risks and complications and the recovery time

Iliotibial band syndrome is usually diagnosed using a combination of your symptoms, medical and exercise history and physical examination.

During your physical examination, your consultant will assess your muscle strength and range of motion. They will gently press (palpate) the areas around your hips and knees to check for pain, tenderness or areas of tightness. They may ask you to perform activities such as running, hopping, or squatting, to observe the way you move and check for any abnormalities.

They may perform tests to assess what triggers your iliotibial band pain and to identify tightness in your iliotibial band.

Some tests for iliotibial band syndrome include:

• Renne’s test: This test involves standing on your affected leg and flexing your knee to 30-40 degrees. The test is positive if this movement causes iliotibial band pain
• Noble’s test: During this test, your consultant will apply pressure to a point on your knee while you perform specific movements to see if it triggers iliotibial band pain
• Ober’s test: This is a test your consultant may use to identify tightness in your iliotibial band

In some cases, your consultant may order imaging tests such as X-rays, MRI or ultrasound scans to rule out other possible causes of your knee pain, like a fracture, meniscus tear or arthritis.

Treatments for iliotibial band syndrome range from home treatments to surgery and depend on how severe your symptoms are and what treatments you have tried previously.

Home treatments 

If your symptoms are mild, the first step in treatment is normally home treatments such as resting the affected leg, avoiding activities that trigger pain and taking over-the-counter painkillers such as ibuprofen to reduce pain and inflammation. Applying ice packs wrapped in a cloth or towel to the area for 20 minutes several times a day can help reduce swelling. 

Physiotherapy 

Physiotherapy for iliotibial band syndrome involves manual therapy like massage and strengthening exercises to build up your muscles and improve your flexibility and range of motion. Your physiotherapist will also advise you on how to reduce the risk of your iliotibial band syndrome from coming back. 

Steroid injections (corticosteroids)

If home treatments and physiotherapy haven’t worked to reduce your symptoms, your consultant may recommend steroid injections to provide short-term pain relief and reduce the inflammation in your iliotibial band.

Surgery

Surgery isn’t usually necessary for iliotibial band syndrome, but your consultant may recommend it if other treatments haven't been effective. Surgery may be performed as keyhole or open surgery and is normally carried out as an outpatient procedure, meaning you’ll usually be able to go home the same day. Recovery from iliotibial band surgery normally takes from a few weeks to several months, depending on the type of surgery you had and other factors such as your age and general health.

Surgery for iliotibial band syndrome includes:

• Iliotibial band lengthening: This is a procedure where your iliotibial band is cut to release tension and allow it to glide more smoothly over your knee
• Soft tissue excision: A minimally invasive procedure to remove any excess or inflamed tissue from around your iliotibial band
• Iliotibial band excision: A part of your iliotibial band is removed to relieve pressure and reduce friction

Iliotibial band syndrome can’t always be prevented, but there are some steps you can take to reduce the risk of iliotibial band syndrome or prevent it from coming back.

These include:

• Increase activity gradually
• Warm up and cool down properly before and after exercise
• Maintain flexibility and strength in your hips, thighs, legs and ankles
• Wear the correct footwear for the activity you are participating in 
• Exercise on a smooth, flat surface and avoid running on uneven or sloping terrain 
• Take adequate rest and allow your body to recover sufficiently after exercise
• Listen to your body and rest, or switch to a different activity if you feel pain or discomfort

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care, including:

• Flexible appointment times and locations that are convenient for you 
• The freedom to choose which hospital and consultant best suits your needs 
• Personalised, consultant-led treatment plans tailored to your individual needs 
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard 
• A range of delicious, healthy meals 
• Affordable, fixed-price packages with aftercare included 
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about iliotibial band syndrome (ITB pain), treatment, book your appointment online or call a member of our team today.

1. Iliotibial Band Syndrome, Johns Hopkins Medicine
2. Iliotibial Band (IT Band) Syndrome, OrthoInfo
3. Iliotibial Band Friction Syndrome, NIH