published 1/30/10, updated 10/14/11

Confused about the location of Iliotibial Band Syndrome?

There is no such thing as “iliotibial band pain” that is not at the knee

by Paul Ingraham, Vancouver, Canada

It’s a chronic point of confusion about iliotibial band syndrome (ITBS) — where does it hurt? Many professionals incorrectly diagnose hip and thigh pain as ITBS.

By definition, ITBS occurs only at a specific location: the side of the knee, around the bump of bone called the lateral epicondyle. The condition is caused by an inflammation of tissues around this structure and no other. The pain is intense, well-defined, with an epicentre you can point to with precision. Pain anywhere else is something else. I promise. I’m not making this up.

The one true location of ITBS pain

The IT band may span from hip to knee, but it’s only at the knee that the dreaded iliotibial band syndrome hurts. Any other kind of pain is some other kind of problem.

The one true location of ITBS pain

The IT band may span from hip to knee, but it’s only at the knee that the dreaded iliotibial band syndrome hurts. Any other kind of pain is some other kind of problem.

Diffuse pain that is difficult to locate is definitely something else. Primary pain that is easy to locate, but on any other part of the leg, is definitely something else. Pain that includes the side of the knee but has no clear epicentre there is definitely something else. To be diagnosed with ITBS, you must have that clear hot spot right the side of the knee.

There is simply no such clinical entity as non-knee ITBS!

Pain in other locations may occur with ITBS, of course. There’s nothing about ITBS that eliminates the possibility of other painful conditions in the region. They may even be related. However, these other pain problems are other pain problems — not iliotibial band syndrome.

Prefer a video explanation? I have a good video tour of basic IT band myths. The first in this video is about the location of ITBS:

3 IT Band Myths & Common Treatment Mistakes 8:11

Hip and thigh pain

Hip pain and thigh pain are common companions of ITBS. Fairly often they are mistaken for ITBS itself. Other times they are mistaken for other problems, like trochanteric bursitis — another common misdiagnosis.

Quick muscle knot orientation

Muscle knots — technically known as myofascial “trigger points” — are a factor in almost all of the world’s aches and pains. A trigger point is a small patch of super-contracted and irritated muscle tissue that can cause symptoms ranging from mild stiffness to extreme pain and a variety of odd side effects. They not only cause pain and problems directly, but also spring to life in response to almost all other painful problems, compounding and complicating them. Even though the existence and importance of trigger points is well known to medical specialists and researchers, most doctors and therapists know surprisingly little or even nothing about them, so misdiagnosis and ineffective treatment are epidemic. For more information about how trigger points might be involved in your own medical history, see SaveYourself.ca’s best-selling tutorial:

SY Save Yourself from Trigger Points & Myofascial Pain Syndrome! — Trigger points (also known as muscle knots) & myofascial pain syndrome, explained and discussed in great detail, including every imaginable self-treatment and therapy option for difficult cases

Although there are many things that can make a hip and thigh hurt, by far the most common is simple muscle pain caused by trigger points (muscle knots). The trigger points themselves are usually in the hips, but the pain often spreads downwards into the thigh. A common and easy example of this phenomenon is Perfect Spot #6, or the (harder to describe and self-treat) tensor fascia latae muscle.

Hip muscle pain is not only a common problem in general — with or without ITBS — but is also potentially implicated in ITBS. For instance, ITBS may because of tight, grouchy hip muscles that control the tension on the IT band. Many ITBS patients seem to experience significant hip discomfort in addition to their strong lateral knee pain. Treating the hip pain may or may not have any effect on ITBS, but is probably worthwhile in itself.

Typical hip muscle pain feels like a deep, nagging ache, that is generally soothed by heat and massage. The pain may be widespread, or fairly well-focussed on the bump of bone on the side of the hip (the greater trochanter).

If you think that you might have hip muscle pain, my muscle pain tutorial should be your next stop:

Of pain sources in the leg itself, the big quadriceps trigger point is a common doozy, Perfect Spot #8, but it tends to dominate the lower end of the thigh.

Non-lateral knee pain

What if you have knee pain that is almost lateral knee pain? It’s still something else! Since the IT band merges broadly with the connective tissue wrappings around the whole knee, occasionally we see IT band syndrome causing symptoms in other parts of the knee — but never clearly. The standard ITBS location must still be clearly dominant for the ITBS diagnosis to stick.

There are many, many kinds of knee pain, with symptoms occurring anywhere around and on the knee. Unlike with the hip, no one condition can explain most of these other cases.

However, patellofemoral pain syndrome (PFPS) is a bucket diagnosis that covers several of the possibilities. PFPS is a condition of many conditions. If you have knee pain with a location that isn’t right for an ITBS diagnosis, it’s probably worth looking at PFPS as a possibility. Generally speaking, PFPS tends to cause pain on the front of the knee.

SY Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence

For a more direct and detailed comparison of ITBS and PFPS, see:

SY The Runner’s Knee Diagnostic Stand-Off — How to tell the difference between the two most common knee pain problems in runners, IT band syndrome and patellofemoral pain