Iliotibial Band Syndrome (ITBS)
ITBS is a common overuse injury in runners and cyclists, but
can often occur in weight lifters, skiers and footballers
(Orchard et al, 1996). ITBS is a result of the friction created
between the ITB and the lateral femoral condyle (outside
knee). During the cycle of running the friction of the ITB
occurs on foot strike where the knee is between 20 and 30⁰
flexion this is the point where the ITB moves from sitting in
front of the lateral femoral condyle, to behind the lateral
femoral condyle, therefore passing over the bony
protrusion (Choi, 2010), irritating the band (see image
below). With ITBS downhill runners are more vulnerable to
sustaining an irritation, while sprinters are less likely, due to
the angles of the knee during the cycle of the stride. As well
as friction to the ITB, recent research of ITBS is starting to
show that inflammation of the fatty tissue or bursa
underneath the ITB can be causing the pain, rather than the
band itself (Brukner P & Khan K, 2006). This can be
determined on examination by the Physiotherapist,
however similar protocols are followed.
Anatomy:
The ITB is a band of dense
fibrous connective tissue that
runs distally down the lateral
(outside) part of your thigh
(Fairclough J et al, 2006). The
band runs from the tensor
fascia lata (TFL) and iliac crest
(top border of the pelvis) along
the gluteus maximus, to the
Gerdy’s tubercle on the lateral
aspect of the tibia, shown in the
diagram right.
Causes:
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Increase in running mileage (Noble, 1980)
Excessive hill running (Noble, 1980)
Poor running technique
Poor biomechanics: Increased foot pronation,
excessive tibial torsion, excessive varum, weak hip
abductors (Noble, 1980 & West R et al, 2009)
Reduced range of motion at the ankle
Leg length discrepancy
Poor footwear (Strauss et al, 2011)
Excessive tightness through ITB
Signs and symptoms:
 Pain on the lateral aspect of the knee, which
becomes progressively worse on the aggravating
activity
 When symptoms first arise, pain can be worse at
the beginning of the activity and start to ease as
you get warm, however this will quickly change as
symptoms worsen
 Swelling/ thickening at the area of discomfort
(outside of knee)
 Snapping or popping sensation as the knee is bent
Diagnosis:
A thorough history is taken, along with a number of tests
can be carried out by your Physiotherapist to help diagnose
the pathology. An MRI or US scan can be carried out, but
will rarely be needed, unless on-going symptoms persist.
Self-treatment:
 Rest from running/cycling

Ice
 Course of anti-inflammatories
 Foam roller (as demonstrated below)
Physiotherapy treatment:
 Deep friction massage
 Myofascial release
 Ischemic pressure
 Dry needling
 Foam roller
 Stretching
 Strengthening
 Biomechanical/running assessment
 Local Corticosteriod injection
 Surgical release: Last resort post all other
intervention
Specialist to Sport Dimensions:
 Close relationship between highly trained
Physiotherapists and Rehabilitation staff
 On site rehabilitation facilities, unique to Sport
Dimensions
 Sister company to The Running School with
specialist running coaches
Prevention:
 Use the exercises provided as preventative
measures before and after training, especially if
you’re a marathon runner, triathlete or even a
recreational runner trying to increase fitness.
 Correctly fitted trainers to help support arches in
feet
 BMA (biomechanical assessment) at the running
school.
Some self-stretching/ rehabilitation exercises:
Foam roller ITB (Iliotibial Band)
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Using foam roller or rolled up towel, place under
knee as shown in image.
Slightly turn foot out
Contract quad and hold for 10 secs
Repeat 3x10 on each leg
Gluteus Medius strengthening
-
Foam roll ITB’s as demonstrated above for approx.
3x1 minute daily on each leg.
ITB stretch
Stretch both ITB’s as
demonstrated in the image left. You
should feel the stretch down the
outside of the back leg.
Hold for 30-40 secs each time
and repeat 3x
-
As shown in the picture have a slight bend at hips
and knees at 90⁰, with feet together.
Slowly lift top knee keeping feet together.
Make sure hips don’t rotate.
You should feel the outside of your hip working.
Repeat 3x10 reps
Quadriceps stretch
-
As demonstrated in the picture above stretch both
quads, holding for 30-40 secs.
Make sure hips are being pushed forward and
knees are together, with a slight bend in the
weight bearing leg.
VMO (Vastus Medialis Oblique) strengthening
References:
 Brukner P & Khan K (2006): Clinical Sports
Medicine, 3rd Edition; pp542-545.
 Choi L (2010): Iliotibial Band Friction Band
Syndrome, in DeLee J, drez D Jr, Miller M, eds:
DeLee: DeLee and Drez’s Orhtopaedic Sports
Medicine, Ed 3. Philidelphia, PA, Saunders Elsevier,
pp 627-628.
 Fairclough J, Hayashi K, Toumi H et al (2006): The
Functional Anatomy of the Iliotibial Band During
Flexion and Extension of the knee: Implications For
Understanding Iliotibial Band Syndrome. Journal of
Anatomy; 208(3): 309-316.
 Kwak S D, Ahmad C S, Gardner T R et al (2000).
Hamstrings and Iliotibial Band Forces Affect Knee
Kinematics and Contact Pattern. Journal of
Orthopaedic Research. ; 18: 101-108.
 Noble C A (1980). Iliotibial Band Friction Syndrome
in Runners. American Journal of Sports Medicine;
8(4): 232-234.
 Orchard J W, Fricker P A, Abud A T, Mason B R
(1996). Biomechanics of Iliotibial Band Friction
Syndrome in Runners. American Journal of Sports
Medicine; 24: 375-379.
 Strauss E J et al (2011). Iliotibial Band Syndrome:
Evaluation and Management. Journal of the
American Academy of Orthopaedic Surgeons; 19:
728-736.
 West R & Irrgang J (2009). Overuse Injuries of the
Lower Extremity, 4th Edition; pp181-183.