In a 13-year-old competitive soccer player with mild post‑exercise lateral upper pelvic pain, could this be proximal iliotibial (IT) band irritation?

Proximal Iliotibial Band Syndrome

This is most likely proximal iliotibial band (ITB) syndrome, a condition that presents with lateral upper pelvic pain at the iliac tubercle in young athletes, particularly in soccer players. 1

Why This Diagnosis Fits

Your 13-year-old competitive soccer player's presentation is classic for proximal ITB syndrome:

• Location: Lateral upper pelvis pain corresponds to the iliac tubercle, where the ITB originates 1
• Activity pattern: Post-exercise pain in a soccer player matches the overuse mechanism 2
• Demographics: While originally described predominantly in female athletes and overweight women 1, this condition occurs in soccer players specifically 2

The ITB originates along the iliac crest with dominant fibers condensing on the iliac tubercle 1. Soccer involves repetitive hip flexion, abduction, and rotation that can strain this enthesis.

Critical Examination Findings to Confirm

Look for these specific clinical signs:

• Point tenderness directly over the iliac tubercle (anterolateral iliac crest) 3
• Positive Ober's test (assesses ITB tightness) 4
• Positive FABER test (Flexion-Abduction-External Rotation) 4
• Pain with resisted hip abduction

Essential Differential Diagnoses to Exclude

You must rule out serious pathology first 5:

• Iliac apophysitis/avulsion - Critical in this age group given open growth plates 6
• Stress fracture of the iliac crest
• Slipped capital femoral epiphysis (SCFE) - age-appropriate concern
• Hip-related pain from FAI syndrome, acetabular dysplasia, or labral pathology 5

However, hip-related pain typically presents as groin pain (not lateral pelvic pain), and absence of groin pain helps exclude FAI syndrome and labral tears 5. The lateral location makes proximal ITB syndrome more likely than intra-articular hip pathology.

Imaging Recommendations

Obtain plain radiographs first (AP pelvis) to exclude:

• Apophyseal avulsion fractures 6
• Bony abnormalities
• SCFE

If radiographs are normal and symptoms persist, consider MRI 5, 1:

• T2-weighted sequences will show increased signal at the ITB enthesis along the iliac tubercle 7, 1
• May reveal associated greater trochanteric bursitis 4
• Never diagnose based on imaging alone - must correlate with clinical findings 5

Treatment Algorithm

Conservative management resolves most cases 4, 2:

1. Relative rest - Modify soccer activities to avoid pain-provoking movements
2. Physical therapy focusing on:
   • ITB stretching (essential for both treatment and prevention) 2
   • Hip abductor strengthening
   • Core stabilization
3. Ice and NSAIDs for symptom control
4. Correct biomechanical factors - assess running mechanics and training errors 2

If conservative measures provide only partial relief after 4-6 weeks, consider ultrasound-guided corticosteroid injection at the iliac tubercle enthesis, which can provide complete resolution 4.

Common Pitfalls

• Missing this diagnosis entirely - Proximal ITB syndrome is rare and underrecognized, especially in adolescents 4, 3
• Inadequate imaging field of view - Standard hip MRI often excludes the iliac tubercle; specifically request inclusion of this area 1
• Assuming all lateral hip pain is greater trochanteric bursitis - The pain location is more superior/anterior in proximal ITB syndrome 3
• Failing to obtain radiographs first - Must exclude apophyseal injury in a 13-year-old 6