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No.5 ITB syndrome



What Is Iliotibial Band Friction Syndrome?

The iliotibial band (ITB) is a thick strip of fibrous tissue that passes down the outside of the thigh and attaches just below the outside of the knee. During running the ITB repeatedly rubs over the outside bony prominence of the knee. The friction caused by this repeated rubbing may lead to an inflammatory response and associated pain and this is what is called iliotibial band friction syndrome (ITBFS).

While running friction between the ITB and the outside bony prominence of the knee generally occurs when the foot hits the ground (heel strike) or just after. Running downhill predisposes a runner to ITBFS because the angle of knee flexion at heel strike is reduced. Sprinting or running faster on even ground reduces the risk of ITBFS as the angle of knee flexion at heel strike is larger than the angle at which friction occurs. 


Signs and Symptoms

If you have ITBFS you will have the following mostly while running however repetitive flexion and extension of the knee will reproduce your symptoms. Generally people with ITBFS will report the symptoms easing on ceasing running.

  • Pain on the outside of the knee while running

  • Tenderness of the ITB near the knee

  • Crepitus may be felt

  • Tightness of the ITB

How Does It Happen?

As ITBFS is an overuse running injury the causes are often associated with biomechanical breakdown, weakness and dysfunction at another body site causing the ITB to take on more stress and begin to breakdown. Like the majority of over use running injuries training errors are more often the cause rather than biomechanical errors but poor foot and lower limb biomechanics also play a big role. Below are some common factors that may increase your risk of developing ITBFS. 

  • Tightness in ITB, gluts and TFL (Tensor fascia Latae)

  • Gluteal weakness and pelvic instability.

  • Poor dynamic pelvic stability

  • Poor running biomechanics

  • Running downhill

  • Running with inappropriate shoes, including proper shoes that have worn out

  • Training errors, particularly increasing intensity, time or frequency too quickly

  • Running on a slanted surfaces (e.g. road camber) or uneven terrain. 

How Do I Treat ITBFS?

The most important thing in the early stages is to reduce the inflammation of the ITB at the point where it rubs on the outside bony prominence of the knee and then to correct the cause of the increased rubbing be it biomechanics, weakness or dysfunction so healing can begin: 

  • Reduce the inflammation through the use of ice, anti-inflammatory medication and electrotherapy

  • Massage and stretching of the tight muscles of the outer thigh and hip 

  • Strengthening of the hip stabilizer muscles

  • Running load and volume should be decreased - especially downhill running and running on cambered surfaces

  • Running shoes that offer extra support should be used. In particular you may need a shoe that offers more control / support on the outside of the shoe. Getting some proper advice from a sports podiatrist or physio who is experienced in dealing with runners and running shoes can be invaluable.

  • Correct poor biomechanics such as foot pronation and lateral pelvic tilt

  • Occasionally a cortiscosteroid injection (to the bursa) or surgery to release the ITB may be necessary.

    Article written by Rob O’Donnell, Physiotherapist and Director of Southern Suburbs Physiotherapy Centre and former Australian Distance running reprasentative. Southern Suburbs Physiotherapy has clinics in 3 loactions:  705 Centre Road East Bentleigh, 100 Lower Dandenong Road Parkdale and 99 Bay Street Brighton and there are physio’s with special interests in treating runners at all locations. For more details go to