INTRODUCTION Iliotibial band syndrome (ITBS) is a com- mon cause of both lateral knee pain and lateral hip pain in sport. In running the incidence can be as high as 12% (1), and the condition is also seen in cyclists (2). ITBS over the knee occurs when the tight ITB repeatedly rubs over the lateral femoral epicondyle, and the bursa cover- ing it (Figs.1a+b), causing friction and tissue irritation. The condition here is often described as ‘runners knee’. The ITB has been shown to thicken from an aver- age of 2.5mm to 5.5mm at the knee, and to develop fluid beneath itself (3). Over the hip, ITBS occurs when the band rubs across the greater trochanter. In this case the condition represents external ‘snap- ping’ hip (coxa saltans) and may give rise to irritation or trochanteric bursitis. Internal snapping hip is a separate condi- tion affecting the iliopsoas tendon.
Although common in athletes, both con- ditions may also occur in the general pop- ulation. ITBS at the hip is a common cause of hip pain in middle age, with pain presenting at night when lying on the unaffected side. This position (adduction and medial rotation of the affected upper hip) places a stretch over the ITB and lengthens the posterior portion of the
gluteus medius muscle. Pain is also often noticed with functional squatting actions (hip flexion) such as sitting down into a low chair.
ITBS is often paralleled by an altered mus- cle balance in the lower limb (4,5). The most common imbalance presenting as lengthening of the gluteus medius muscle
Tensor fascia lata
and tightening of the iliotibial band and tensor fascia lata muscle.
STRUCTURE The deep fascia of the lower limb is collec- tively called the fascia lata. It attaches to the outer lip of the iliac crest between the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). In