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Iliotibial band (ITB) syndrome (runner’s knee)

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Iliotibial band (ITB) syndrome (runner’s knee)

What is it?

The iliotibial band (ITB) is a strong tendon running down the outer side of the thigh that connects a hip muscle (called tensor fascia muscle) to the shinbone *tibia) just below the knee joint.

Close to the knee joint this tendon crosses a bony lump known as the lateral femoral condyle. Repetitive exercise such as running and cycling can aggravate a bursa (fluid filled sac)which lies between this bone and tendon creating inflammation; this is known as iliotibial band syndrome (ITB) or runner’s knee.

How is it caused?

ITB syndrome is most commonly seen in runners and cyclists who undertake repetitive exercise for prolonged periods of time. It is commonly seen in athletes who have come back from injury, for example an ankle sprain, and return at their previous high level of activity.

What are the symptoms?

Symptoms include pain and aching on the outer side of the knee in addition to tenderness and sometimes swelling.

ITB pain classically comes on at a reproducible time during exercise. Runners often describe pain developing for example 5km into a run. This pain can cause them to stop running altogether.


ITB is diagnosed based on history and clinical examination findings.

MRI and ultrasound can also be used to confirm the diagnosis.

What is the treatment?

Prevention is the best form of treatment and relies on regular stretching before and after exercise.

Established ITB syndrome is best treated initially with a combination of rest and physiotherapy. Physiotherapy focuses on muscle / tendon stretching exercises in combination with muscle strengthening exercises concentrating on weak muscle groups, commonly the hip muscles (Glutei) and quadriceps (vastus medialis obliquis or VMO).

A local anaesthetic and steroid injection can also be injected into the bursa (inflamed area around the knee) which may provide pain relief and improved ability to perform physio exercises.

If this does not improve your symptoms, Mr Barnett may recommend an ultrasound guided injection of botulinum toxin (BOTOX) into the hip muscle at the origin of the ITB.

This injection essentially relaxes the iliotibial band and eases pain. This then enables you to work hard with the physio to strengthen and use other weaker muscles around the knee to prevent ITB syndrome from returning.

This BOTOX injection tends to last for approximately 3 months and can be repeated if necessary.

If all non-operative treatment fails, a small day case operation may be performed to lengthen the ITB surgically preventing recurrence in most cases.

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