INTRODUCTION

ANATOMY
Iliotibial Tract
The iliotibial tract, also known as the
iliotibial band, is a thick strip of connective
tissue connecting several muscles in the
lateral thigh. It plays an important role in
the movement of the thigh by connecting
hip muscles to the tibia of the lower leg.

Located on the lateral edge of the fascia

lata, the iliotibial tract forms a wide sheath
of fibrous connective tissue that surrounds
the lateral thigh. It arises at its proximal
end from the tendons of the tensor fasciae
latae and gluteus maximus muscles. From
its origin, the iliotibial tract travels along
the lateral side of the thigh and across the
knee joint, inserting on the lateral epicond
Iliotibial Tract
The iliotibial tract, also known as the
iliotibial band, is a thick strip of connective
tissue connecting several muscles in the
lateral thigh. It plays an important role in
the movement of the thigh by connecting
hip muscles to the tibia of the lower leg.

It is an important fascia of the body,

surrounding and connecting the muscles
of the body to surrounding tissues. Like all
other deep fascia, it is made almost
exclusively of dense regular connective
tissue. Dense regular connective tissue is
a form of fibrous connective tissue that is
extremely strong, tough, and avascular. It
is made almost exclusively of collagen
fibers and fibroblast cells, which produce
collagen. Collagen is the strongest protein
found in nature and is one of the strongest
structures in the entire human body. The
collagen fibers are arranged in a regular
pattern of straight lines, giving the iliotibial
tract incredible strength in the direction in
which muscle force is applied to it and
considerably less strength in other
directions. A small number of elastin
protein fibers are also found intermingled
with the collagen fibers to permit a degree
of elasticity in the tissue.

Functionally, the iliotibial tract extends the

tensor fascia latae muscle into the lower
thigh and leg, allowing it to function as an
abductor, medial rotator and flexor of the
thigh. It also allows the tensor fascia latae
and gluteus maximus muscles to support
the extension of the knee while standing,
walking, running and biking
Etiology
The etiology of ITBFS is multifactorial.
Many causative factors have been
postulated, few with overwhelming
evidence supporting them.
ITBFS usually is caused by overuse,
which is mostly due to errors in training.
Single-session errors cause ITBFS as
often as repetitive deficiencies. Sudden
changes in surface (ie, from soft to hard or
from flat to uneven or a decline), speed,
distance, shoes, and frequency can break
down the body faster than it can heal,
causing injury. Other factors frequently
reported are the following:
Limb-length discrepancy
Genu varum
Overpronation
Hip abductor weakness
Myofascial restriction
PATHOPHYSIOLOGY
ITBFS typically is observed in people who
exercise vigorously. The overuse creates
stress that the body cannot repair, and
soft-tissue breakdown occurs.[] When the
knee flexes, the ITB moves posteriorly
along the lateral femoral epicondyle.
Contact against the condyle is highest
between 20° and 30° (average, 21°); thus,
when the band is excessively tight or
stressed, the ITB rubs more vigorously.
A small recess is formed between the
lateral femoral epicondyle and the ITB as
it travels along the lateral thigh to the tibial
plateau. This space was believed to have
a separate bursa lying deep to the band,
but studies revealed it to be synovium that
is a lateral extension and invagination of
the actual knee joint capsule (lateral
synovial recess [LSR]). The LSR lies
underneath the ITB and acts as an
interface between the ITB and the lateral
femoral epicondyle.
Histologic analysis demonstrates
inflammation and hyperplasia in the
synovium, whereas magnetic resonance
imaging (MRI) studies have demonstrated
diffuse signal abnormality below the band
and in the synovium but not in the ITB.
This suggests that this syndrome is not a
tendinopathy. Variance is observed in the
congenital thickness of the band; patients
with thicker bands may be predisposed to
ITBFS.
In runners, friction occurs near or just after
foot strike during the contact phase of the
gait cycle. Downhill running reduces the
knee flexion angle and can aggravate
ITBFS, whereas sprinting and fast running
increase the knee flexion angle and are
less likely to cause the
syndrome. [, , , , ] The friction point at the
lateral epicondyle prominence is
illustrated in the image below.

Illustration of the friction point at the lateral

epicondyle prominence. Note the shift in
position of the iliotibial band from anterior
to posterior as the knee moves into
flexion, drawing the iliotibial band across
the prominence.
Clinical Significance of Iliotibial Band
Iliotibial Band Syndrome
Iliotibial band syndrome is a condition
caused probably by the friction of the tract
moving across the tissues on the lateral
side of the thigh.
The iliotibial band is not attached to the
bone as it courses between the Gerdy
tubercle and the lateral femoral
epicondyle. This lack of attachment allows
it to move anteriorly and posteriorly with
knee flexion and extension. This
movement has been hypothesized to
cause the iliotibial to rub against the
lateral femoral condyle, causing
inflammation.
Another theory is that instead of friction, it
is the compression of iliotibial band
against a layer of innervated fat between
the band and epicondyle that causes the
problem.
This condition is common in runners and
cyclists.