ITB Syndrome

What did you think I was talking about?  Long Slow Distance (LSD) running is notorious for being associated with ITB Friction Syndrome, nicknamed "Runners Knee" because it is a frequent occurrence with runners.  It is also caused by other activities, but running seems to dominate the landscape.  With the Gold Coast Marathon fast approaching it is popping up more frequently here. 

The iliotibial band (ITB) is a thick band of fascia that runs down the lateral side of the thigh extending from the outside of the pelvis and inserting just below the knee1. The ITB acts to distribute the contractile forces from the muscles that feed into it; those muscles are the tensor fascia latae (TFL) and gluteus maximus (GM). It is a key component of stabilising the knee during activities involving the lower limb such as running and cycling. As the leg moves through the gait cycle the knee flexes and extends causing the insertion of the ITB to move across the lateral epicondyle of the knee joint, which can cause an irritating rubbing sensation inflaming the area and resulting in ITB Syndrome (ITBS) [1].

ITBS is one of the most common injuries that runners experience and accounts for up to 12% of all running injuries[2,3]. Symptoms range from a stinging sensation, to swelling or thickening of the tissue in the area where the band moves over the femur. Pain is most commonly felt when the foot strikes the ground and may be present above or below the knee where the ITB attaches to the tibia. The pain usually presents itself just after heal contact and is aggravated by the length of time running and may get progressively worse as the run progresses. Downhill and running long distances are two factors that can cause an increase in symptoms [4].

Treatment for Iliotibial Band Syndrome can be divided into three phases. The initial phase involves reducing the pain and inflammation around the knee and increasing the mobilisation of the ITB, the application of ice, resting and anti-inflammatory drugs can be used to help speed up this phase. The second phase involves massage or dry needling and stretching, the ITB is a non-contractile structure (it does not shorten in length) and cannot become ‘tight’ as some would have you believe. Cadaveric studies have revealed that the ITB is capable of increasing a whole 0.02% of its total length [3]. As the TFL and GM contract they compress the ITB pulling it taught over the quadriceps muscle vastus lateralis (VL). Over time with the continued compression the ITB can get stuck to the VL via the connective tissues becoming intertwined forming adhesions and so we need to look at the surrounding musculature the TFL and the glutes for the increased tension.

Research into people with ITBS has indicated that people with this condition have increased hip abduction along with greater knee internal rotation, both findings thought to be caused by underlying weakness and fatigability or the hip abductors. We look to address this weakness in the third phase of treatment, which can only be initiated once exercises can be performed painlessly. The third phase involves strengthening the hip abductors to help correct the altered biomechanics caused by the tension. Exercises such as clams, lateral leg raises and quarter squats are a great starting point on the road to recovery.


When it comes to sorting your sports injuries, come in to see one of our highly skilled physiotherapists.  We can help get you over the finish line of your next race. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined.  We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give us a call on (02) 8411 2050 to get started on a journey to a better you.



  1. Meardon SA, Campbell S, Derrick TR. Step width alters iliotibial band strain during running. Sports Biomech. Nov 2012;11(4):464-472.
  2. Fredericson M, Wolf C. Iliotibial Band Syndrome in Runners. Sports Medicine. 2005;35(5):451-459.
  3. Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. Aug 2010;20(4):580-587.
  4. Fullem BW. Overuse lower extremity injuries in sports. Clin Podiatr Med Surg. Apr 2015;32(2):239-251.
  5. Bruckner, Kahn. Clinical Sports Medicine 4th Edition. Australia: Mcgraw-Hill; 2012.