What are causes of iliotibial band syndrome (ITBS)?

Updated: Apr 27, 2020
  • Author: John M Martinez, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Iliotibial band syndrome (ITBS) typically is due to overuse. The injury is seen most commonly in runners, although other athletes (eg, cyclists, tennis players) also may be affected. The usual mechanism is irritation of the iliotibial tract as it crosses over the lateral femoral condyle and, less commonly, the greater tuberosity. Increased tension or friction of the ITB in this area can result in an increase of irritation or inflammation. Abnormal gait or running biomechanics also have been implicated. [5, 6, 10, 11, 17, 18]

Cyclists may experience ITBS due to improper positioning on their bike. Excessive internal or medial rotation of bike cleats and a bike seat that is too high are 2 main causes of ITBS among cyclists.

Long-distance runners have a higher incidence of ITBS than do short-distance runners and sprinters. This higher incidence may be due to the change in the biomechanics of running versus sprinting. Long-distance runners tend to have a more prominent and extended heel-strike and stance phase in comparison with sprinters. The ITB is under its greatest tension during the first third of the stance phase.

A study by Phinyomark et al found that external rotation of the hip was significantly more pronounced in female runners with ITBS than in healthy female runners and male runners with ITBS, while ankle internal rotation was significantly greater in male runners with ITBS than in healthy male runners. The study included 48 runners with ITBS and 48 healthy controls. [19]

A literature review by Aderem and Louw indicated that in shod female runners with ITBS, peak knee internal rotation and peak trunk ipsilateral flexion are greater during the stance phase of running than they are in healthy runners. [20]

A study by Stickley et al indicated that increased knee-varus angle and maximum knee-adduction moment increase the risk for development of iliotibial band syndrome (ITBS). Vertical stiffness was found to be lower in study patients with ITBS. [21]

Weakness of muscle groups in the kinetic chain may also result in the development of ITBS. Weakness in the hip abductor muscles, such as the gluteus medius, may result in higher forces on the ITB and the tensor fascia lata. A literature review by Mucha et al, for example, suggested that a link exists between hip abduction weakness and ITBS in distance runners. [22]

Seijas et al reported evidence that ITBS can develop as a result of hip arthroscopy, with increased postoperative range of motion and local inflammatory changes possibly being factors in this. [23]

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