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ITB Syndrome Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.


- Overus­e/tight ITB
- Runners and cyclists more suscep­tible
- Compre­ssion of fat pad between ITB and epicondyle
- Traction perios­tit­is/­ent­hes­opathy from tensile strain on femoral attachment of distal ITB

Demogr­aph­ics­/Risk factors

- Repetitive knee flexion and extension while in single leg stance
- Runners, Cycling, weight lifting, skiing, soccer, basket­ball, field hockey, compet­itive rowing
- TFL Hypert­onicity
- High mileage running
- Running on circular track (shortens ITB)
- Weak/f­atigued hip abductors - alllows excessive adduction of the thigh and int rot of the knee during stance phase
- Pes cavus (pes planus­/hy­per­pro­nation of the foot unlikely cause)


- Sharp/­burning pain (2cm superior to lateral joint line of the knee)
- Pain can radiate slightly proxim­all­y/d­istally
- Aggravated by repetitive knee flexion and extension
- TTP over lateral femoral epicondyle
- +ve Nobles, Obers test
- Hypertonic psoas and TFL
- Hip abductor weakness


- Usually not beneficial
- MRI useful to rule out other diagno­sis­/un­res­ponsive to conser­vative care
- Oedema present over lateral epicon­dyl­e/t­hic­kening of distal ITB
- US


- Lateral meniscus injury
- OA
- Stress f#
- LCL Sprain
- Hamstring tendin­opathy


- Streng­thening of hip abductors and ext rot (clam, side bridge, posterior lunge
- NSAIDs­/St­eroids
- Massag­e/STW of ITB - Foam roller
- Joint restri­ctions of Lx, SI, LL
- Leg length inequality
- Lower duration of exercise - slow paced running on flat surface
- Minimise downhill running and avoid running on banked surfaces
- If track work unavoi­dable, runners should reverse directions each mile
- Avoid running on wet/icy surfaces - require greater TFL activation for stabil­isation
- Avoid stair climbers, squats and dead lifts
- Cyclists may need to adjust seat height and avoid toe in pedal positions
- Surgery considered if no better with conser­vative care >6 months