causes of IT Band Syndrome

My Knee Hurts: Do I have IT Band Syndrome?

Diagnosis
IT Band Syndrome is usually diagnosed simply by evaluating symptoms. The pain and irritation is always at the outer side of the knee. The pain is felt as a stinging, stabbing, needle-like pricking, or aching sensation that progresses rapidly while running. A dull pain radiates up the IT band along the outside of the leg. There may be inflammation but there is normally no swelling.

Most common IT Band Syndrome symptoms include:

  1. Pain that is substantial after running a few miles. Then quickly becomes an intense stabbing sensation that makes running too painful.
  2. Pain peaks around the moment the foot strikes the ground when running.
  3. Pain felt strongly when pressure is applied to the area with a finger or thumb.
  4. Little or no pain when walking stiff legged.
  5. Some pain when walking normally.
  6. Increased pain when walking or running downhill.
  7. Increased pain when going downstairs.
  8. An increase in irritation as a result of riding a bike significant distances.
  9. An increase in irritation as a result of playing sports with abrupt knee movements such as basketball or tennis.
  10. Some pain when getting up after sitting for a long period. Connective tissue such as the IT band can tighten when sitting and not in use. 
  11. An increase in irritation after a few deep knee bending activities.
  12. An increase in irritation as a result of repeated knee bending such as driving a car with a foot clutch.
  13. No obvious abnormal structural issues in the legs.
  14. The pain diminishes after a few weeks of rest. The pain comes back when resuming activities such as running.

ITBS_Knee

Pain on the front side of the knee is likely the other type of runner's knee called patellofemoral pain syndrome (PFPS) also know as patellar tendinitis / patellar tendonitis or jumper's knee. Click here to view more on PFPS.

PFPS_Runners_Knee

Associated symptoms may include:

  1. Snapping, popping, or clicking sensation at the knee. This is more likely caused by a lateral meniscus tear. The snapping is slightly lower than the lateral epicondyle of the femur. The snapping may be associated with IT Band Syndrome, however, this is simply because a tight IT band can increase muscle and tendon tension and thereby intensify the snapping. This can be checked by placing fingers on the knee, sitting on a chair, and bending the knee back and forth.Click here to learn more about why knees snap, pop, or click.

ITBSKneeLateralMeniscusTear

  1. Hip pain where the IT band passes over the femur may be associated with IT Band Syndrome but is not termed IT Band Syndrome. This is called trochanteric pain syndrome (TPS), also known as trochanteric bursitis, and is inflammation of the trochanteric bursa, a part of the hip. Like IT Band Syndrome, TPS can be a result of overuse, a tight IT band, weak muscles, etc. TPS is much less common than IT Band Syndrome.Click here to read more on TPS.

GreaterTrochantericPainSyndrome

Considerations:

  1. Note that IT Band Syndrome is more common in older adults as connective tissue such as the IT band loses its elasticity with age. 
  2. Note that IT Band Syndrome is more common in less active individuals as connective tissue such as the IT band looses its elasticity with lack of use. 

A full physical evaluation may be performed of the lower back, legs, hips, knees, and ankles and look for other potential causes of outer knee pain. Blood tests and X-rays are usually not helpful. Common examinations include Nobel's test, Renne's test, and Ober's test.

Nobel's Test
The Nobel test checks for pain on the outside of the knee when bent at about 30 degrees. IT Band Syndrome sufferers typical feel pain most at 30 degrees since this is the angle where the IT band compresses most tightly against the bony outcropping (epicondyle) of the knee. The patient lies down with their knee first bent at about 90 degrees. The examiner applies pressure with their thumb to the outside of the knee. The examiner slowly extends the leg until the knee is bent to about 30 degrees. Feeling pain at this angle suggests the presence of IT Band Syndrome.  This is a simple test you may be able to try at home with a partner.

Click here to view an article on Nobel's test.

Renne's Test
The Renne's test is similar to Nobel's test. It checks for pain on the outside of the knee when bent at about 30 degrees. IT Band Syndrome sufferers typically feel pain most at 30 degrees since this is the angle where the IT band compresses most tightly against the bony outcropping (epicondyle) of the knee. The patient first stands without bending their knees. The examiner applies pressure with their thumb to the outside of the knee. The patient slowly squats until their knees are bent to about 30 degrees. Feeling pain at this angle suggests the presence of IT Band Syndrome. This is a simple test you may be able to try at home with a partner.

Click here to view an article on Renne's test.

RenneTest5

Ober's Test
Ober's test is used to evaluate tightness of the IT band and to check for pain at the outside of the knee. A tight IT band does not necessarily mean that one has IT Band Syndrome. However, a tight IT band may be an underlying contributor to IT Band Syndrome.

In the Ober's test, the patent lies on their side with the leg to be tested on top. The examiner positions the patient so that their hip is slightly bent and the knee is bent to about 90 degrees. The examiner supports the weight of the patent's leg. The examiner then straightens the leg so that it is bent to about 5 degrees. The examiner slowly lowers the leg using gravity to find it's resting position. A leg that does not lower significantly indicates a tight IT band and a patient that may be prone to IT Band Syndrome. Pain in the outer area of the knee suggests the presence of IT Band Syndrome. The Modified Ober's test is similar, however, the hip and knee are not bent.

Click here to view an article on Ober's test.

MRI
An MRI can be used to see inflammation caused by IT Band Syndrome. My MRI is shown here. The lateral condyle of the femur is shown. The IT band shows as a dark line and passes around the lateral condyle. Inflammation shows as white. 

MRI1

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