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I was an active physical therapist once but I've had a family and been out of commission for years. One of my teenage sons has iliotibial band syndrome. I used to know how to treat that but many things have changed in medicine. What's the latest treatment for this problem? I might still be able to offer some help.

s you know, iliotibial band (ITB) syndrome is an overuse problem that is often seen in bicyclists, runners, and long-distance walkers. Athletes who participate in skiing, rowing, triathlons, and field hockey have also reported ITBS as a problem limiting their sports activities. As mentioned, it causes pain on the outside of the knee just above the joint. For those who are reading this who don't know, the ITB is actually a long tendon. (Tendons connect muscles to bone.) It attaches to a short muscle at the top of the pelvis called the tensor fascia lata. The ITB runs down the side of the thigh and connects to the outside edge of the tibia (shinbone) just below the middle of the knee joint. You can feel the tendon on the outside of your thigh when you tighten your leg muscles. The ITB crosses over the side of the knee joint, giving added stability to the knee. The lower end of the ITB passes over the outer edge of the lateral femoral condyle, the area where the lower part of the femur (thighbone) bulges out above the knee joint. When the knee is bent and straightened, the tendon glides across the edge of the femoral condyle. The ITB glides back and forth over the lateral femoral condyle as the knee bends and straightens. Normally, this isn't a problem. But the bursa (fluid-filled protective pad) between the lateral femoral condyle and the ITB can become irritated and inflamed if the ITB starts to snap over the condyle with repeated knee motions while walking, running, or biking. In long distance runners, impingement of the iliotibial band against the lateral femoral condyle causes enough friction to create this condition. As the knee bends 30 degrees and straightens fully (to zero degrees), the iliotibial band slides through an area called the impingement zone. People often end up with ITB syndrome from overdoing their activity. They try to push themselves too far, too fast, and they end up running, walking, or biking more than their body can handle. The repeated strain causes impingement leading to this syndrome. Some experts believe that the problem happens when the knee bows outward. This can happen in runners if their shoes are worn on the outside edge, or if they run on slanted terrain. Others feel that certain foot abnormalities, such as foot pronation, cause ITB syndrome. Pronation of the foot occurs when the arch flattens. An accurate diagnosis and examination is important so that the proper treatment can be applied. For example, impingement versus bursitis versus flat feet would be treated differently from a tendon that is simply too short and too tight. In almost all cases, conservative care is tried first before considering surgery. The physical therapist evaluates each patient and performs clinical tests (e.g., Ober's test, Noble test, Thomas test) that assess iliotibial band tightness and function. A program of activity modification, stretching, manual therapy (e.g., soft-tissue mobilization to break up adhesions), and equipment change are key features of the physical therapy program. The therapist will also evaluate the athlete's equipment (shoes, cleat type and position, bicycle seat and handlebars) and make recommendations for changes. Running form and training programs are reviewed and instruction given to reduce iliotibial band impingement. With your background, it sounds like you can easily apply some of these ideas and at least see if any change can be brought about. If not, then a visit to a sports physician, orthopedic surgeon, or physical therapist may be needed. The goal of all treatment is to return the athlete to pain free full participation in sports and activities.


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