ITB Syndrome

ITB Syndrome

Article by John Miller

ITB Syndrome

(ITB Friction Syndrome)

What is 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. It results from repeated trauma rather than a specific incident.

The ITB attaches to a bony bump (femoral condyle) on the outside of the knee. It slides forwards and backwards across this thin 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 while 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?

ITB syndrome

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 connects to your tibia (lower leg bone) and femoral condyle on the lower outside portion of the thigh bone.

What Causes ITB Syndrome?

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

The most common causes include:

  • Poor biomechanics (running technique); mainly 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
  • A sudden increase in mileage for training
  • Excessive hill training (mainly 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 a 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 four 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 critical 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, your physiotherapist will rarely require diagnostic imaging to confirm your diagnosis.

To determine if you are suffering ITB syndrome, please consult your physiotherapist.

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 of the actual cause of your ITB friction syndrome.
  • Reduce acute pain and inflammation.
  • De-load your IT band.
  • Assist you with modifying your exercise or training regime to reduce pain and prevent a 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 the removal of the irritating piece of soft tissue on the outside of your knee. This surgery is a last resort, as most cases respond well to conservative treatment or physiotherapy.

Running InjuriesPost-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.

ITB Stretches

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

For specific information, please consult your running or knee physiotherapist.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.