ITB Syndrome

adrian wong physio

Article by J. Miller, A. Wong

What is ITB Syndrome?

Iliotibial Band Friction Syndrome

ITB Syndrome

ITB Syndrome (Iliotibial friction syndrome) is one of the most common causes of "Runner's Knee" and can account for up to 22% of overuse injuries in runners. Being an overuse injury, it is caused by repeated trauma rather than a specific incident.

The ITB attaches to a bony protuberance (femoral condyle) on the outside of the knee. It slides forwards and backwards across this bony point with movement. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which commonly happens just as your foot strikes the ground in running. This region of 30 degrees of knee flexion is called an “Impingement Zone” or pinching of irritated structures over the outside of the knee, thereby producing ITB Friction Syndrome.

What is the Iliotibial Band?

The ITB, or iliotibial band, is a long, thin band of fascia that runs down the outside of your thigh. At the top of your thigh it is attached to your Tensor Fascia Latae (TFL) muscle, and Gluteus Maximus and at the bottom it attaches to your tibia (lower leg bone) and femoral condyle on lower outside portion of the thigh bone. 

What Causes ITB Syndrome?

Essentially ITB friction syndrome is caused by altered running biomechanics due to underlying muscular imbalances.Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.

The most common causes include:

  • Poor biomechanics (running technique); particularly inwards rolling knees and hips
  • Weak hip / gluteal muscles
  • Weak hip rotators
  • Weak inner quadriceps
  • Weak core muscles
  • Poor foot arch control
  • Worn out or unsuitable runners
  • Sudden increase in mileage for training
  • Excessive hill training (particularly downhill)
  • Endurance running (training for ½. and full marathons, ultra-marathons)

What are the Symptoms of ITB Syndrome?

There are varying degrees of severity of ITB Friction Syndrome. The most common symptoms include:

  • Sharp or burning pain just above the outer part of the knee
  • Pain that worsens with continuance of running or other repetitive activities
  • Swelling over the outside of the knee.
  • Pain during early knee bending 
  • Gradual onset of symptoms which if they persist for greater than 4 weeks can cause major sport or activity interference.

How is ITB Syndrome Diagnosed?

On examination, your physiotherapist or sports doctor will look for signs of ITB Friction Syndrome. The important diagnosis is discovering “what is causing” the problem. If this isn’t determined ITB friction syndrome will persist on a return to running. With a thorough assessment, further investigations, such as scans are not required.

ITB Syndrome Treatment


Many patients with ITB Friction Syndrome start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:

  • Diagnosis the actual cause of your ITB friction syndrome.
  • Reduce acute pain and inflammation.
  • Deload your IT band.
  • Assist you with modifying your exercise or training regime to reduce pain and prevent recurrence.
  • Normalise joint range of motion or your hip.
  • Strengthen your knee, hip and leg muscles
  • Normalise your lower limb muscle lengths.
  • Improve your proprioception, agility and balance.
  • Correct your running and landing technique and function.

ITB Surgery

In severe cases, some patients choose to undergo a surgical release of the iliotibial band which is called a Z-lengthening procedure. It entails removal of the irritating piece of structure that overlies the femoral condyle on the outside of the knee. This is a last resort as most cases respond well to conservative treatment or physiotherapy. 

Post-operative rehabilitation is one of the most important, yet too often neglected, aspects of surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. 

For more information, please ask the advice of your physiotherapist.

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ITB Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Foam Roller
  • Heat Packs
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • ITB Stretches

    ITB stretches are difficult to perform and often have minimal impact. ITB rollers are an excellent method to normalise your ITB length.

    ITB Roller Small
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    ITB Roller Small
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    FAQs about ITB Syndrome

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Barefoot Running: Your MUST READ Guide to the Pro's and Con's.
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • How Can You Prevent a Future Leg Injury?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • Runners: How to Reduce Your Knee Stress
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Helpful Products for ITB Syndrome

    ITB Friction Syndrome

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    Last updated 14-Feb-2019 10:43 AM

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