What is IT band syndrome, and who gets it?

What the IT band is

The iliotibial band is not a muscle. It is a thick sheet of connective tissue that starts at the hip, where it blends with the gluteal muscles and a small muscle called the tensor fasciae latae, and runs down the outside of the thigh to attach just below the knee on the shin bone.

It helps stabilise the hip and knee when you stand on one leg, which happens with every running stride. Because it is anchored to the thigh bone along much of its length, it does not slide freely back and forth as was once believed.

Why it becomes painful

Current understanding is that pain comes from compression of a richly supplied layer of fat and tissue between the band and the bony bump on the outside of the knee, the lateral femoral epicondyle. This compression is greatest at a small angle of knee bend, which is exactly where the knee spends time with every running stride.

When training load rises faster than these tissues can adapt, they become inflamed and sensitive. The joint surfaces, meniscus and ligaments are usually unaffected.

Who tends to get it

It is most common in distance runners, especially those increasing mileage, and in cyclists who ride long distances or have an incorrect saddle height. Hikers going down long descents, rowers, and recruits on marching programmes are also affected.

In Qatar we often see it in people preparing for an organised run or a half marathon, in new runners who started training indoors on treadmills and then moved outdoors, and in regular cyclists on long rides in the cooler months.

How it is diagnosed

Diagnosis is clinical. Dr. Gelber looks for tenderness over the outer knee bone, reproduces the pain by pressing there while bending and straightening the knee, and assesses hip strength and the way you move. Imaging is reserved for unusual or persistent cases, mainly to exclude other causes of outer knee pain.