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