Iliotibial band syndrome (ITBS) is a condition that occurs when the tendon becomes inflamed from friction at the lateral femoral condyle (LFE) and compression of soft tissues at the region. It is the result of overuse of the lateral aspect of the knee (outer region) and can cause subsequent irritation and swelling. IIliotibial band syndrome is a common injury among athletes and encompasses over 22% of lower extremity injuries. It is also the source of many lateral knee pains and can occur in one or both legs (bilateral iliotibial band syndrome). 

Iliotibial band syndrome is categorised by the level of pain and extent of obstruction faced when performing activities. 

These grades are: 

• Grade 1: pain on the outer part of the knee after conducting an exercise. Pain is described as a “generalised pain” which subsides within 24 hours after rest or inactivity. 

• Grade 2: “burning/radiating pain” is felt during or when completing an exercise but does not affect the general performance of an activity.
• Grade 3: pain is significant and inhibits the performance of an exercise. One may feel restricted in terms of mobility and clearly observe a reduction in efficiency.
• Grade 4: pain starts to impact day-to-day activities. One may undergo extreme discomfort and former peak performance become unattainable.
• Grade 5: pain significantly disrupts exercises and day-to-day living. At this stage, one may observe a sharp decline in quality of life. 

There are a few factors that could lead to the occurrence of iliotibial band syndrome, these are:

• Congenital anatomical features: certain anatomical conditions that some individuals are born with may predispose them to iliotibial band syndrome. These include foot pronation, varus knee, prominent lateral condyle, a tight iliotibial band, leg length discrepancy, and weak hip abductors.
• Training errors: wearing improper footwear, cooling down too quickly, or insufficient warm-ups may lead to iliotibial band syndrome. 
• Abrupt motion: certain movements such as running downhill too quickly or swerving at turns abruptly could injure the iliotibial band tract. 

• Knee and hip pain
• Clicking sensations (a snap, pop, or click) on the lateral outer aspect of the knee
• Crepitus (crackling) in the hip or knee
• Warmth and redness 

However, one may be unconscious of the pain if the injury is categorised as first or second grade iliotibial band syndrome. It may mistakenly be dismissed as muscle soreness from training. The ability to identify pain may also be hindered if one generally has high tolerance towards pain. 

• Existing health condition: individuals with arthritis in the knee tend to be susceptible to iliotibial band syndrome.
• Gender: women are more prone to iliotibial band syndrome potentially attributed to their wider hips and increased Q angle (the angle between the thigh bone and the kneecap). 
• Athletes: iliotibial band syndrome is a common lower extremity injury amongst runners. Cyclists, skiers, and football players also tend to be prone to iliotibial band syndrome potentially attributed to the long-distance exertion nature of these sports. 

• Physical examination and medical history: inform your orthopaedist of the potential activities that may have led to an injury such as trauma, exercise, or sports. Physically the area of injury will be examined and motion tests such as the Ober test and Noble test are sufficient in diagnosing iliotibial band syndrome.
• Imaging tests: magnetic resonance imaging (MRI) may be required to rule out conditions such as meniscus or LCL injuries. If necessary, an ultrasound may be conducted to obtain a clear visualisation of soft-tissue swelling, collection of fluid, inflammation of the bursa (bursitis), or the thickening of the iliotibial band. 

Treatment methods may be employed to increase the speed of recovery, these treatment options are: 

• Medications: given that iliotibial band syndrome is primarily an inflammatory condition, non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment to reduce inflammation and manage pain.
• Injections: corticosteroid injections may be used to manage pain and relieve symptoms associated with iliotibial band syndrome. 
• Rest: rest from physical activity is usually prescribed until symptoms reduce, this may range between 2-4 weeks. 
• Physiotherapy: physiotherapy is fundamental in the treatment of iliotibial band syndrome. Your orthopaedist may concurrently conduct them during the rest period or prescribe them after observing complete inactivity. The physiotherapy employed would depend on the severity of the condition and the specifics of the injury that has occurred. 
• Arthroscopic surgery: surgery is often the last line of treatment deployed. Surgery is an option for athletes who are in a time crunch to return to sports activities or where the condition has exacerbated and is causing unmanageable interferences in quality of life. Surgery would involve the removal of a part of the iliotibial band tract which is causing friction or inflamed bursa and cysts if any are identified.