From the Research
Diagnosis of iliotibial band syndrome primarily relies on clinical evaluation, including a thorough history and physical examination, as supported by the most recent study 1 from 2018. Patients typically present with lateral knee pain that worsens with repetitive activities like running or cycling. The pain is often localized to the lateral femoral epicondyle, about 2-3 cm above the joint line, and may radiate up the thigh or down the leg. Key physical examination findings include:
- Tenderness over the lateral femoral epicondyle
- A positive Noble test (pain with knee flexion at 30 degrees while applying pressure to the lateral femoral condyle)
- A positive Ober test (limited adduction of the hip in side-lying position) The modified Thomas test may reveal tight hip flexors, and the patient may demonstrate weakness in hip abductors. Imaging is generally not necessary for diagnosis but can help rule out other conditions; plain radiographs are typically normal, while MRI might show thickening or edema of the iliotibial band, as noted in a case study 2 from 2013. Diagnostic ultrasound can be useful to visualize inflammation between the iliotibial band and lateral femoral epicondyle. Differential diagnoses to consider include:
- Lateral meniscal tears
- Lateral collateral ligament sprain
- Patellofemoral pain syndrome
- Proximal tibiofibular joint instability Early diagnosis allows for prompt treatment with activity modification, stretching, strengthening exercises, and addressing biomechanical factors that contribute to excessive tension on the iliotibial band, as discussed in a study 3 from 2005 and another study 4 from 2011.