Iliotibial Band Friction Syndrome and Greater Trochanteric Bursitis
UW Health's Sports Medicine doctors treat a wide range of common athletic injuries, including iliotibial band (ITB) friction syndrome and greater trochanteric bursitis (GTB), overuse conditions experienced by many runners and bikers.
About Iliotibial Band (ITB) Friction Syndrome and Greater Trochanteric Bursitis (GTB)
Iliotibial band (ITB) friction syndrome and greater trochanteric bursitis (GTB) are common overuse conditions that frequently affect individuals that participate in activities that require repetitive hip and knee flexion and extension, such as running and bicycling.
The ITB is made of fibrous connective tissue, which extends from the front of the hip (pelvis), progresses down the outside of the upper leg until it crosses the outside of the knee, and inserts into the front and outside of the shin bone (tibia). The muscles that insert into the upper portion of the ITB are the gluteus muscles and the tensor fascia lata. Tightness and weakness in these muscle groups may be a contributing factor in symptoms of both ITB friction syndrome and GTB.
In simple terms, the ITB can be viewed as a large rubber band which extends from the outside of the upper leg and crosses two joints, the hip and the knee. Repetitive rubbing of the ITB across the bony prominences of the hip and knee causes an inflammatory response and pain.
The greater trochanteric bursa is a fluid-filled sac that cushions the tendon of the gluteus medius muscle as its inserts into a bony prominence (the greater trochanter) on the outside of the hip.
Repetitive motion in this area can cause the greater trochanteric bursa to become irritated and painful.
Signs and Symptoms
ITB friction syndrome is an achiness or pain typically found over the outside of the knee. The onset of this pain usually occurs toward the middle or end of running or bicycling. It is not unusual for the pain or achiness to continue after completion of the exercise. A snapping sensation also may occur on the outside of the knee or hip.
Symptoms of GTB are usually noted over the outside of the hip or upper leg with point tenderness over the outside of the hip and occasionally snapping. Similar to ITB friction syndrome, achiness and pain usually occurs toward the end of running or bicycling, although the symptoms may persist well after exercise ends.
Potential Predisposing Factors
Several factors may lead to ITB or GTB, including:
- Excessive bow-leggedness (genu varum)
- Weakness of core muscles such as the “glutes” and abdominals
- Overpronation (internal rotation) of the foot/ankle joint with impact
- Leg length that is not the same from one side to the other
- Improper training from insufficient warm-up and/or cool-down, insufficient post-exercise stretching, overtraining or running on a crowned surface (such as a road) or short track
Treatment and Prevention
Individuals have several treatment options and ways to prevent ITB and GTB, including:
- Performing quality warm-up and cool-down activities prior to and after exercise
- Stretching the ITB and hip muscles regularly
- Using a foam roller to assist with deep tissue massage
- Wearing running shoes fitted with orthotics
- Avoiding crowned surfaces and running on the same side of the road every time
- Progressing exercise routines in a planned fashion without increasing distance, speed or intensity too quickly
- Decreasing or stopping exercise if symptoms occur or do not get better
- Injecting the GTB with cortisone if other conservative treatment does not improve symptoms