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Practice 10-Minute Consultation

Iliotibial band syndrome

BMJ 2019; 364 doi: (Published 21 March 2019) Cite this as: BMJ 2019;364:l980
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Patient information sheet available

A printable guide to iliotibial band syndrome, including activities and stretches to aid return to exercise

This article has a correction. Please see:

  1. James Pegrum, orthopaedic fellow1,
  2. Alex Self, consultant radiologist2,
  3. Nick Hall, general practitioner3
  1. 1Nuffield Orthopaedic Centre, Oxford, UK
  2. 2The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
  3. 3Leckhampton Surgery, Cheltenham, UK
  1. Correspondence to J Pegrum jpegrum{at}
  • Accepted 5 February 2019

What you need to know

  • Iliotibial band (ITB) syndrome (ITBS) is the most common cause of lateral knee pain in runners, but may be provoked by other activities such as swimming, rowing, cycling, and hiking

  • Activity modification and ITB stretches can be recommended in primary care

  • Consider referral to physiotherapy for biomechanical and sport specific rehabilitation when severe or not responding to initial management

A 25 year old woman has recently started training for her first marathon. When she increased her typical running distance from 10 to 18 km she started getting lateral knee pain and tightness. It occurs at the same distance each time she runs, and is worse when she runs downhill.

Iliotibial band (ITB) syndrome (ITBS) affects 7-14% of runners,12 although it is associated with a variety of activities including cycling, field sports, hockey, rowing, swimming, hiking, and basketball.1 The pain or tightness typically affects the lateral knee but can radiate along the length of the ITB, presenting with hip or thigh pain (fig 1). ITBS is usually caused by biomechanical abnormalities, often combined with overtraining, although it can develop with quite modest levels of exercise. This article outlines how to diagnose ITBS in someone presenting with lateral knee pain, and offers a practical guide to initial management in primary care.

Fig 1

Iliotibial band syndrome

What you should cover

Understanding the location and pattern of the pain and biomechanics is important to evaluate and treat the condition. The assessment and differential diagnosis is summarised in the table .

View this table:

Common causes of lateral knee pain


  • You might ask

  • Where is the exact site and what activities (both sport and sedentary) exacerbate the symptoms? (table )

  • What sports do you participate in? Is the pain relieved at rest? Has your training intensity …

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