Ask the Docs | Iliotibial Band Friction Syndrome (ITBS)

Ask the Docs

Posted July 12, 2006

Patient Question:

I’m a semi-active cyclist, more of a weekend warrior, really. I have been experiencing sharp burning pain on the outside of my left knee, and even occasionally in both knees. What is causing this pain?

Dr. Nikhil Verma:

The description of your injury sounds very much like Iliotibial Band Friction Syndrome, or ITBS for short. ITBS is very common with runners (making up nearly 12% of all running-related overuse injuries) and is also associated with cycling and triathlon activities.

ITBS occurs when the Iliotibial Band (a muscle on the outside of the thigh) rubs against the femur (thigh bone), causing inflammation. The condition can result from any activity that causes the leg to turn inward repeatedly including wearing worn-out shoes, running downhill or on banked surfaces, running too many track workouts in the same direction, or extensive cycling with the hip flexed in the aero/time trial position.

Unlike many overuse injuries, however, ITBS pain afflicts seasoned and recreational athletes alike. In your case, the injury may be caused by biking too hard and too fast when your body isn’t up to the challenge. (You did say that you are a “weekend warrior,” didn’t you?) Also, poor form or improper equipment fit may be producing a hip angle that is causing the Iliotibial friction.

Dr. Verma
Dr. Verma

Treatment Options:

Treating ITBS can be challenging due to the underlying myofascial restrictions that can contribute to a patient's condition. Through a comprehensive examination, an orthopaedic sports medicine physician can identify trigger points (specific points of irritation) as well as tenderness and possible swelling of the Iliotibial band.

Recreational athletes typically improve with a simple regimen of anti-inflammatory medication and appropriate stretching exercises. Competitive athletes, however, often require a more comprehensive treatment approach. After acute symptoms are alleviated with activity restriction and medication, problematic trigger points can be managed with massage therapy or other treatments. An ongoing stretching and strengthening program can help keep ITBS from becoming a chronic injury.

For more information about Dr. Verma and the Sports Medicine physicians of Midwest Orthopaedics at Rush, call 877.MD BONES or visit them online at

The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.

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