Iliotibial band syndrome (ITBS), as an overused injury of the lower extremities, has developed into a common cause of lateral knee pain. At present, the treatment of ITBS includes drug therapy, muscle strength training, physical therapy, and surgical treatment. Among these methods, physical therapy, drug therapy, and surgical treatment can only alleviate the symptoms of patients. As a safe and effective treatment, lower limb muscle strength training can improve patients' muscle strength, correct abnormal gait, and reduce the recurrence rate of the disease by paying attention to the dynamic changes of patients' recovery process. At present, the pathogenesis of ITBS remains unclear, and the treatment methods are not unified. It is necessary to further study the biomechanical factors related to the lower extremities and develop more scientific and comprehensive muscle strength training methods.

Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome.

Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.

Cycling is a popular sport, and the cycling population and prevalence of related injuries and diseases increase simultaneously. Iliotibial band friction syndrome is a common chronic overuse injury caused by repetitive knee use in cycling. Self-myofascial release using foam rollers is an effective intervention for this syndrome; however, studies reporting positive results on self-myofascial release in cycling are limited. Therefore, this study investigated the effect of self-myofascial release on pain and iliotibial band flexibility, heart rate, and exercise performance (cadence, power, and record) in adult male cyclists with iliotibial band friction syndrome. We evaluated the pain and exercise ability of the control (n = 11) and self-myofascial release (n = 11) groups before and after cycling twice. Significant differences were observed in the pain scale, the iliotibial band flexibility, and cycling pain and power. The posterior cadence of the self-myofascial release group was 3.2% higher than that of the control group. The control group's record time increased by 74.64 s in the second cycling session compared to the first cycling session, while that of the self-myofascial release group decreased by 30.91 s in the second cycling session compared to the first cycling session. Self-myofascial release is effective in relieving pain and may improve cycling performance by increasing the iliotibial band flexibility.

Trochanteric bursitis (TB), also known as greater trochanteric bursitis (GTB) or greater trochanteric pain syndrome (GTPS) is a common disorder and frequent cause of lateral hip pain. The bursa, a small fluid-filled sac, acts as a lubricating medium for nearby gluteus tendons to gracefully slide over during the physiologic range of motion. The trochanteric bursa is located on the lateral aspect of the hip, lying superficial to the hip abductor musculature and deep to the iliotibial band (ITB). Due to its superficial position and proximity to large tendons, the trochanteric bursa can become inflamed and is a common pain generator and a common reason for presentation to the orthopedic surgeon or family physician. Inflammation to the bursa can be due to repetitive microtraumas such as running or exercise, tendinopathy of surrounding musculature, gross trauma including fall from a height with direct compression to the bursa, or inflammation can be idiopathic without a discernable cause. Diagnosis is clinical and based primarily on history and physical examination although imaging, including plain film radiographs, is important to rule out other causes of hip pain. Treatment modalities are nearly exclusively nonoperative in nature and include non-steroidal anti-inflammatories (NSAIDs), physical therapy and stretching, and cortical steroid injections are often provided for pain relief. Surgical excision of the trochanteric bursa is reserved for refractory cases that do not respond to nonoperative treatment. 

Ultrasound (US) therapy in sports and medical pathologies is widely used by many physiotherapists and sports medicine clinicians; however, data regarding their potential side effects remain rare. We report a case of a 21-year-old woman with iliotibial band (ITB) syndrome treated with a physiotherapy session combined with US therapy. She had twenty 7 min US sessions on the knee, for 3 months (US at 1 Mhz with an intensity between 1 and 2 W/cm2). Due to persistence of the ITB syndrome's symptomatology after the 3 months of physiotherapy sessions, an MRI (magnetic resonance imaging) was carried out and revealed osteonecrosis-like bone abnormalities on the external femoral condyle, the external tibial plateau, and the proximal fibula. In view of these lesions, the ultrasonic therapy was stopped, and a repeat MRI demonstrated the progressive disappearance of these imaging abnormalities one year after the last US (ultrasound) treatment. In light of this case, we propose here a short review of reported osseous "osteonecrosis" abnormalities associated with US therapies.

Multiple surgical techniques have been described to treat refractory iliotibial band syndrome. However, there is lacking evidence demonstrating superiority of one technique over the other and limited audiovisual resources. Most surgical procedures aim to release the iliotibial band; nevertheless, few focus on reducing concomitant inflammation. The present article illustrates a Z-plasty lengthening technique associated with local bursectomy for treating iliotibial band syndrome refractory to conservative treatment.

Snapping hip syndrome, also known as coxa saltans (or dancer’s hip), is a clinical condition characterized by an audible or palpable snapping sensation that is heard during movement of the hip joint. Snapping hip has multiple etiologies and is classified based on the anatomic structure that is the cause/source of the snapping sensation. Historically, two main snapping hip categories were recognized: Extra-articular. Intra-articular. The term intra-articular snapping hip has relatively fallen out of favor due to the increasing knowledge of intra-articular pathologies.  These etiologies include loose bodies (e.g. secondary to synovial chondromatosis) or labral tears of the hip.[1][2][3] As the clinical terminology evolved, extra-articular snapping hip eventually became subclassified into: External snapping hip. Internal snapping hip. External snapping hip is most commonly attributed to the iliotibial band moving over the greater trochanter of the femoral head during hip movements in flexion, extension, and external or internal rotation.  Other causes include the proximal hamstring tendon rolling over the ischial tuberosity, either the fascia lata or the anterior aspect of the gluteus maximus rolling over the greater trochanter, and the psoas tendon rolling over the medial fibers of the iliacus muscle. A combination of defects is also possible; for example, thickening of both the posterior iliotibial band and anterior gluteus maximus, which snap over the greater trochanter at the same time. [4][5] Internal snapping hip most commonly occurs as the iliopsoas tendon snaps over underlying bony prominences, such as the iliopectinal eminence or the anterior aspect of the femoral head. Other causes include paralabral cysts and partial or complete bifurcation of the iliopsoas tendon. The snapping sensation can closely mimic intra-articular pathology since they both originate from the anterior hip area. Close physical exams and imaging can differentiate the two. It should be noted, however, that in approximately 50% of internal snapping hip cases, an additional intra-articular hip pathology is identified.

The iliotibial band tract or IT band (ITB) is a longitudinal fibrous sheath that runs along the lateral thigh and serves as an important structure involved in lower extremity motion. The ITB is also sometimes known as Maissiat's band.  The ITB spans the lower extremity on its lateral aspect before inserting on Gerdy's tubercle on the proximal/lateral tibia.  Proximally in the thigh, the ITB receives fascial contributions from the deep fascia of the thigh, gluteus maximus, and tensor fascia lata (TFL).[1]  The TFL is the deep investing fascia of the thigh, encompassing the muscles of the hip and lower extremity around this region.[2] Distally, the ITB becomes a distinct soft tissue layer of the lateral knee.[3] There are multiple clinical conditions that can present secondary to a spectrum of ITB dysfunction and many of these manifest in physical laborers to recreational or high-level professional athletes.  Moreover, these conditions will vary depending on the specific anatomic location of the dysfunction.  For example, proximally based ITB conditions include external snapping hip syndrome, which occurs secondary to ITB friction as these fibers rub (or "snap") over the greater trochanter of the femur[4]  Distally, ITB pathology most commonly manifests as some form of lateral-based knee pain (commonly ITB syndrome, or ITBS).  Athletes affected are often involved in sports heavily reliant on peak lower extremity function and performers, such as runners, skaters, or cyclists.   Regardless of the ITB condition, most patients experience complete resolution of symptoms following nonoperative management modalities alone.  However, surgical consideration is a potential option for chronic, recurrent, or recalcitrant cases that continue to persist despite exhausting of all nonoperative management options after several months.

Physical activity has many health-related benefits, including prevention and management of chronic disease, weight management, and improved mental health. Active girls and women of all ages and abilities are at risk of relative energy deficiency in sport, a syndrome encompassing low energy availability, menstrual irregularities, and disordered bone metabolism. Presence of amenorrhea or oligomenorrhea may suggest reduced energy availability. Active females are at risk of overuse injuries, including patellofemoral pain syndrome, iliotibial band syndrome, and stress fractures; treatment usually includes activity modification, a period of rest, and physical therapy. Active females are also at risk of acute injuries, including concussion and anterior cruciate ligament injuries. Pregnant patients without contraindications who were physically active before pregnancy can continue these activities, and those who were not previously active may gradually increase their activity level to a goal of 150 minutes per week. Moderate exercise during pregnancy reduces the risk of gestational diabetes mellitus, preeclampsia, and cesarean delivery. Postpartum exercise focused on core and pelvic floor strengthening can improve pelvic floor dysfunction. Supervised exercise programs focused on strength and balance have been consistently shown to reduce the risk of falls and injurious falls in older women.

Patients with femoroacetabular impingement syndrome (FAIS) often have extra-articular disorders, such as external snapping hip (ESH). We recommend that obvious ESH be addressed by endoscopic transversal iliotibial band (ITB) release during hip arthroscopy for FAIS because the residual serious snapping caused by ESH negatively affects the outcome of hip arthroscopy. However, for mild ESH without indications for severe trochanteric bursitis on magnetic resonance imaging, we still propose that physical therapy, extracorporeal shock wave therapy, or local injection be performed for pain relief. Surgical interventions for ESH including the Z-plasty technique and the modified Z-plasty technique for lengthening the ITB, as well as endoscopic cruciate or transversal incision in the ITB for release, have been reported with good results. Every technique has advantages and disadvantages, and we believe that surgeons should perform ITB release for ESH at the time of hip arthroscopy for FAIS based on their personal experience and inclination. In any case, excessive release of the ITB should be avoided. Finally, we wish to propose that more attention should be paid to the peri-greater trochanter (GT) space, an anatomic space between the ITB and the GT, which is similar to the subacromial space in the shoulder joint. Greater trochanteric pain syndrome (GTPS), related to the peri-GT space, is a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and ESH. Precise diagnosis and proper procedures for concurrent GTPS during surgery may improve the outcome of arthroscopy in patients with both FAIS and GTPS.

Knee pain has been reported to limit mobility and impair quality of life in 25% of adults. Iliotibial band syndrome (ITBS) is one of the many different causes of lateral knee pain. It was first seen in US Marine Corps recruits during their training in 1975 and has been diagnosed frequently in long-distance runners, cyclists, skiers, and participants of hockey, basketball, and soccer since then. These activities all depend on rapid and prolonged cycling of the knee through flexion and extension. This article will discuss how this cycling can cause the syndrome, as well as, discuss evaluation and treatment modalities.  The iliotibial band (ITB) is the distal fascial continuation of the tensor fascia lata, gluteus medius, and gluteal maximus. It traverses superficial to the vastus lateralis and inserts on the Gerdy tubercle of the lateral tibial plateau and partially to the supracondylar ridge of the lateral femur. There is also an anterior extension called the iliopatella band that connects the lateral patella and prevents medial translation of the patella. The ITB functions as a knee extensor when the knee is less than 30 degrees of flexion but becomes a knee flexor after exceeding 30 degrees of flexion. The ITB has been postulated to acquire a more posterior position relative to the lateral femoral epicondyle with increasing degrees of flexion.

Iliotibial band traction syndrome (ITBTS) after total knee arthroplasty (TKA) has been well documented following first-generation guided motion bicruciate substituting (BCS) TKA. The incidence of ITBTS following second-generation BCS has been found to be rare, and surgical release of the IT band has not been reported. A 64-year old male was diagnosed with ITBTS following second-generation guided motion BCS TKA. After a three-month trial of non-surgical treatment, he underwent selective open release of the iliotibial band (ITB), which successfully relieved his symptoms. Orthopedic surgeons should keep ITBTS as a possible differential diagnosis when evaluating the lateral-sided knee pain following guided motion BCS TKA.

Impingement syndromes are caused by anatomic variability of normal structures, altered biomechanics, or a combination of both. Imaging manifestations of painful impingement syndromes can explain patient symptoms and guide appropriate management. This article discusses the MR imaging findings associated with synovial plica syndrome and other impingement syndromes of the knee joint. Relevant embryology and anatomic variation of synovial plicae are presented, with emphasis on features predisposing to patient symptoms. The most common knee impingement syndromes are reviewed including iliotibial band fraction syndrome, Hoffa fat pad impingement/lateral patellar tendon lateral femoral condyle friction syndrome, and suprapatellar/quadriceps fat pad impingement.

Greater trochanteric pain syndrome (GTPS) is clinically defined as greater trochanter pain with mechanical characteristics. The most common diagnosis is gluteal tendinopathy. Most cases of gluteal tendinopathy resolve with conservative management. In case of refractory pain endoscopic surgical treatment can resolved symptoms. This article presents a prospective study of endoscopic proximal fascia lata release associated to trochanteric bursectomy for recalcitrant trochanteric pain syndrome. 33 patients (35 hips) with refractory pain during more than six months were included. All patients were treated by endoscopic iliotibial band release and bursectomy according to Ilizaliturri. Outcomes were assessed by using Harris hip score and Womac hip score. Patients were follow-up until one year after surgery. The mean age was 53.7 years old, there was 9 men and 24 women. There were two bilateral cases in the female group. The average duration of conservative treatment was 20 months (CI95 9 to 31 months). 68% of patients were satisfied of the surgery with disappearance of pain after surgery. WOMAC and Harris hip score significantly improved after surgery until 6 months (respectively from 67 to 29 and from 40 to 76 - p<0.05). No complication was reported. Age, body mass index and duration of conservative treatment did not influence surgical results. This study showed that the endoscopic ilio tibial band (ITB) release and trochanteric bursectomy is simple, safe and easily reproductible but future prospective studies with a larger number of patients are required.

The hip can have a multitude of different pathologies leading to different symptoms. Greater trochanteric pain syndrome, historically attributed to bursitis, has been largely found to be associated with lesions of the gluteus medius and minimus tendons, and the prevalence of gluteus medius pathology in patients with femoroacetabular impingement (FAI) is as high as one-third of the FAI population. If a patient is found to have significant clinical symptoms of both FAI and a gluteus medius tear, it is imperative to fix both pathologies. The most important diagnostic predictor in hip arthroscopy is not magnetic resonance imaging but a well-executed history and physical exam. We use a quadrant approach: the medial quadrant accounts for adductor bursitis, adductor tears, pudendal neuralgia, or sports hernias. The posterior quadrant may account for a hamstring tear, lumbar radiculopathy, ischiofemoral impingement, or in rare cases piriformis syndrome. The anterior quadrant accounts for more intraarticular pathologies including FAI, Labral tears, osteoarthritis, avascular necrosis, or iliopsoas bursitis. The lateral quadrant would include greater trochanteric pain syndrome, gluteus medius and minimus tears, external snapping hip syndrome and iliotibial band syndrome. By using this systematic approach and using the magnetic resonance imaging to confirm the diagnosis, we may accurately determine patients' hip pathologies.

Greater trochanteric pain syndrome (GTPS) groups together several causes of lateral hip pain, buttock pain, and thigh pain. These include greater trochanteric bursitis, gluteal medius tendinopathy or tears, gluteal minimus tendinopathy or tears, and iliotibial band snapping.[1] Furthermore, patients may have both co-existing bursitis and tendinopathy. Greater trochanteric bursitis is characterized by localized lateral hip pain that typically presents with focal tenderness over the greater trochanter. Patients often endorse worsening pain by walking upstairs, sitting up from a chair, or laying with the affected side down.[2][3] On physical exam, the most common finding is pain with palpation over the greater trochanter. Exquisite pain on palpation over the trochanter is the key clinical diagnostic indicator differentiating itself from primary hip pathologies, which typically radiate towards the groin.  In addition, active abduction and passive adduction of the hip may exacerbate pain.[4] GTPS is more common in women, overweight patients, and patients between 40 and 60 years old. It has been suggested that the larger pelvic width in women may cause increased tension on the iliotibial band over the greater trochanter. In addition, patients with GTPS may have co-existing back pain, hip joint osteoarthritis, and conditions that alter lower extremity mechanics, such as knee pain resulting in abnormal forces around the hip.[1] GTPS is diagnosed clinically and does not have specific diagnostic criteria. Imaging results are variable and may show bursitis, gluteal tendinopathy, or no bursal inflammation.[5][6]

The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.

Greater trochanteric pain syndrome (GTPS) refers to pain in the lateral hip and thigh and can encompass multiple diagnoses including external snapping hip (coxa saltans), also known as proximal iliotibial band syndrome, trochanteric bursitis, and gluteus medius (GMed) or gluteus minimus (GMin) tendinopathy or tearing. GTPS presents clinicians with a similar diagnostic challenge as non-specific low back pain with special tests being unable to identify the specific pathoanatomical structure involved and do little to guide the clinician in prescription of treatment interventions. Like the low back, the development of GTPS has been linked to faulty mechanics during functional activities, mainly the loss of pelvic control in the frontal place secondary to hip abductor weakness or pain with hip abductor activation. Therefore, an impairment-based treatment classification system. is recommended in the setting of GTPS in order to better tailor conservative treatment interventions and improve functional outcomes.

The knee is a complex joint with many fascial and ligamentous interactions. The movement in multiple planes makes the knee a prime site for friction syndromes, especially in active individuals. The most common friction syndrome is the iliotibial band friction syndrome. This occurs commonly in runners and cyclists and can be diagnosed clinically in a patient with lateral knee pain during activity. The anterior fat pads of the knee can also be the site of friction syndromes, most often in the Hoffa fat pad. Edema here can be located in the superolateral aspect of the fat pad when associated with patellar abnormalities, or diffusely when impingement is due to other causes. Edema of the quadriceps or prefemoral fat pad may also cause anterior knee pain and may be diagnosed with magnetic resonance imaging. The posteromedial friction syndrome and medial tibial crest syndrome are rare causes of medial knee pain highly active individuals.

This study evaluated the outcomes of arthroscopic surgery for the treatment of external snapping hip at 2- to 10-year follow-ups. Eighteen patients with refractory external snapping hip treated by arthroscopic surgery were enrolled in this prospective study. All patients underwent unsuccessful conservative treatment for more than 3 months before surgery. We made diamond-shaped defects on the iliotibial band and resected peripheral fibrosis tissues for iliotibial band release with an arthroscopic approach. The visual analog scale (VAS), modified Harris hip score and return to previous level of activity were evaluated as functional outcomes. In addition, residual discomfort or the presentation of complications was also investigated. The average follow up period was 7 years. The modified Harris hip score increased from 70.08 preoperatively to 93.14 postoperatively, and the VAS score decreased from 3.67 preoperatively to 1.17 2 weeks after the operation and declined to 0.33 at the last follow-up. Neither recurrence of snaps nor complications were recorded. Two patients complained of a tight sensation with tenderness after exertion. Our clinical outcomes were compatible with those of previous studies, and no long-term complications were noted, even with a relatively longer follow-up period than what was reported in previous studies. Arthroscopic surgery is a safe and effective treatment that can provide promising long-term clinical outcomes for patients with refractory external snapping hip.

The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this "new" structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a comprehensive understanding of the healthy behaviour of the ITB, and this is necessary prior to further investigating the aetiology of pathologies like ITBS. Therefore, the purpose of this narrative review was to collate the anatomical, biomechanical and clinical literature to understand how the mechanical function of the ITB is influenced by anatomical variation, posture and muscle activation. The complexity of understanding the mechanical function of the ITB is due, in part, to the presence of its two in-series muscles: gluteus maximus (GMAX) and tensor fascia latae (TFL). At present, we lack a fundamental understanding of how GMAX and TFL transmit force through the ITB and what mechanical role the ITB plays for movements like walking or running. While there is a range of proposed ITBS treatment strategies, robust evidence for effective treatments is still lacking. Interventions that directly target the running biomechanics suspected to increase either ITB strain or compression of lateral knee structures may have promise, but clinical randomised controlled trials are still required.