From the Guidelines
Iliotibial band syndrome (ITBS) is diagnosed primarily through clinical evaluation, with key diagnostic criteria including lateral knee pain that typically worsens with repetitive knee flexion activities like running or cycling. The diagnosis of ITBS is mainly based on clinical findings, including a thorough medical history and physical examination. Key diagnostic criteria include:
- Lateral knee pain that worsens with repetitive knee flexion activities
- Pain localized to the lateral femoral epicondyle, approximately 2-3 cm above the joint line
- Sharp or burning sensation during activity that may subside with rest
- Tenderness to palpation over the lateral femoral epicondyle
- A positive Noble compression test, which involves pain with pressure applied to the lateral knee while flexing from 30° to 0° 1
- Sometimes a positive Ober test indicating IT band tightness The pain typically occurs at about 30 degrees of knee flexion, known as the impingement angle. While diagnostic imaging is generally not necessary, it may be used to exclude other conditions, and ultrasound (US) can be useful in evaluating medial plicae and following patients with iliotibial band syndrome 1. Risk factors that support the diagnosis include recent increases in training volume, downhill running, leg length discrepancies, excessive pronation, and weakness in hip abductors. The absence of mechanical symptoms, joint effusion, or instability helps differentiate ITBS from intra-articular pathologies like meniscal tears or osteoarthritis.
From the Research
Diagnostic Criteria for IT Band Syndrome
- The diagnosis of IT band syndrome is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities 2.
- Clinical symptoms, physical examination, and MRI are used to diagnose IT band syndrome, but there is no uniform diagnostic criteria 3.
- Ober's test for iliotibial band tightness is a common diagnostic tool for IT band syndrome 4.
Common Diagnostic Characteristics
- Lateral knee pain associated with repetitive motion activities is a common symptom of IT band syndrome 2.
- Friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa are proposed etiologies for IT band syndrome 2.
- The kinetics and kinematics of the hip, knee, and/or ankle/foot appear to be considerably different in runners with IT band syndrome compared to those without 5.
Limitations of Current Diagnostic Criteria
- There is limited or conflicting evidence on the aetiology of IT band syndrome in runners 5.
- The methodological quality of research into the management of IT band syndrome in runners is poor, and the results are highly conflicting 5.
- Clinical tests used to diagnose IT band syndrome have not been validated for this patient group 5.