Iliotibial Bursitis

What is Iliotibial Bursitis

Iliotibial bursitis is inflammation of the bursa on the outside of the knee.

A bursa is a fluid-filled sac that is often found near a joint.

The main function of a bursa is to reduce friction between adjacent moving structures.

Bursas act as cushions to help tendons glide smoothly over bony surfaces during joint movement.

Typically, bursae are located around large joints such as the shoulder, knee, hip, and elbow.

Inflammation of this fluid-filled structure, iliotibial bursa is called Iliotibial bursitis. 

The iliotibial bursa is located beneath a long tendon (iliotibial band) that connects muscles of the buttock, hip, and upper leg to the outside of the shin bone.

This condition is also called iliotibial band friction syndrome.

What are the causes?

This condition is caused by repeated rubbing of the tendon over the bursa, which occurs with repetitive activity. This friction causes fluid to build up inside the bursa. The bursa swells, and that causes pain in the area where it is located.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Doing athletic activities that involve repetitive squatting, running, cutting, and side-to-side movements.
• Overtraining, or starting a new athletic activity without gradually increasing your time and distance.
• Participating in certain sports, such as:
  • Basketball.
  • Cross country running.
  • Football.
  • Rugby.
  • Racquet sports.
  • Soccer.
  • Volleyball.
  • Cycling.
• Being 50–80 years old and having knee arthritis.
• Being a middle-aged woman who is overweight.
• Having flat feet or knee deformities.
• Having diabetes.

What are the symptoms?

Symptoms of this condition include:

• Pain on the outside of your knee. The pain may also be felt on the outside of your leg near the knee.
• Pain that gets worse with activity, especially stairs or prolonged walking or running.
• Tenderness when pressing on the side of your knee.
• Knee swelling that may or may not include increased warmth or redness.

How is this diagnosed?

This condition is usually diagnosed based on your symptoms, your medical history, and a physical exam. During the exam, your health care provider will check your:

• Knee motion.
• Knee strength.
• Amount of pain when the outside of your knee is touched or pressed on.
• Ability to do activities such as walking or stairs.

Rarely, other tests may be done to rule out other causes of your symptoms. These tests may include:

• MRI.
• Ultrasound.
• An injection of numbing medicine into the bursa to see if the pain will go away.

How is this treated?

Treatment for this condition may include:

• Avoiding activities that cause pain and swelling.
• Icing your knee.
• Wearing an elastic wrap or sleeve to support your knee.
• Keeping your knee raised (elevated) when resting.
• Taking an NSAID to reduce pain and swelling.
• Getting injected with a numbing medicine and an anti-inflammatory medicine (steroid).
• Doing stretching and strengthening exercises.

Treatment usually improves the pain in 6–8 weeks. Surgery is sometimes needed to drain or remove the bursa.

Follow these instructions at home:

If you have a compression wrap or sleeve:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the wrap or sleeve if your foot or toes tingle, become numb, or turn cold and blue.
• Do not let the wrap or sleeve get wet.
• Keep the wrap or sleeve clean.

Managing pain, stiffness, and swelling

• If directed, put ice on the knee.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Elevate your leg above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.

Contact a health care provider if:

• You have pain that is not relieved by rest or treatment.
• Your symptoms get worse or do not improve with home care.

Iliotibial Bursitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your leg. These exercises also help to relieve pain and stiffness.

Exercise A: Quadriceps stretch, prone

1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Lunge (adductor stretch)

1. Stand and spread your legs about 3 feet (about 1 m) apart. Put your left / right leg slightly back for balance.
2. Lean away from your left / right leg by bending your other knee and shifting your weight toward your bent knee. You may rest your hands on your thigh for balance. You should feel a stretch in your left / right inner thigh.
3. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Hamstring stretch, supine

1. Lie on your back.
2. Hold both ends of a belt or towel as you loop it over the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
3. Straighten your left / right knee and slowly pull on the belt to raise your leg. Stop when you feel a gentle stretch in the back of your left / right knee or thigh.
   1. Do not let your left / right knee bend.
   1. Keep your other leg flat on the floor.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your leg. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Quadriceps wall slides

1. Lean your back against a smooth wall or door while you walk your feet out 18–24 inches (46–61 cm) from it.
2. Place your feet hip-width apart.
3. Slowly slide down the wall or door until your knees bend as far as told by your health care provider. Keep your knees over your heels, not your toes. Keep your knees in line with your hips.
4. Hold for __________ seconds.
5. Push through your heels to stand up to rest for __________ seconds after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Straight leg raises (hip abductors)

1. Lie on your side, with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up with each other. You may bend your bottom knee to help you balance.
2. Lift your top leg 4–6 inches (10–15 cm) while keeping your toes pointed straight ahead.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position. Allow your muscles to relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Straight leg raises (hip extensors)

1. Lie on your abdomen on a firm surface. You can put a pillow under your hips if that is more comfortable.
2. Tense the muscles in your buttocks and lift your left / right leg about 4–6 inches (10–15 cm). Keep your knee straight as you lift your leg.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position.
5. Let your leg relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Bridge (hip extensors)

1. Lie on your back on a firm surface with your knees bent and your feet flat on the floor.
2. Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs.
   1. Do not arch your back.
   1. You should feel the muscles working in your buttocks and the back of your thighs. If you do not feel these muscles, slide your feet 1–2 inches (2.5–5 cm) farther away from your buttocks.
3. Hold this position for __________ seconds.
4. Slowly lower your hips to the starting position.
5. Let your buttocks muscles relax completely between repetitions.
6. If this exercise is too easy, try doing it with your arms crossed over your chest.

Repeat __________ times. Complete this exercise __________ times a day.