Lackluster Leg - Iliotibial Band Syndrome

Q: I am a 30-year-old woman who has exercised her entire life. I have run four marathons, but each time I train at long distances my iliotibial band (ITB) becomes a problem. I get a sharp pain on the side of my leg just above the knee.

Sometimes I feel a snapping or popping in my hip or around my knee. During my last marathon, it was so severe it felt like my knee was going to collapse, and I had to stop, stretch, and walk for a while. I do stretch regularly.

Could you explain what causes iliotibial band syndrome and suggest anything else I can do to clear up this annoying problem? Is my marathon "career" over?

S.P.
Sandy, UT

A: The ITB is a thick strip of fibrous connective tissue that runs from the top of the pelvic bone and along the outer side of the leg to just below the knee, where it attaches to a bony protuberance of the lower leg.

As your knee flexes, the ITB rubs over the femur (thigh bone). With increased mileage or a new training style it can fatigue, tighten, and rub excessively. The rubbing is accentuated the more you lift your knees.

Usually the ITB becomes irritated either directly over the bony protuberance at the side of the hip, or on the side of the leg an inch or two above the knee, but it can become inflamed along the entire length. A sharp pain is usually felt near the surface, sometimes accompanied by a snap or pop.

The pain can be reproduced by standing on the affected leg and then bending the knee 30 degrees or by pressing directly over the band as it crosses over the femur. Other conditions can mimic ITB pain, so a careful evaluation by a sports medicine specialist is essential.

This irritation can seem like a minor annoyance at first and then go on to become a major problem due to the underlying cycle of inflammation, swelling, and scarring. ITB syndrome represents 20 to 25 percent of knee injuries in runners.

What causes ITB syndrome?

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