Iliotibial Band Friction Syndrome

Illiotibial Band Friction Syndrome

What is it?

The iliotibial band (ITB) is a thickening of the fascia that envelops the thigh, it acts as a lateral stabiliser of the knee and is an extension of the tensor fascia late and gluteus maximus muscles, which then travels down the outside of the thigh to insert into the front of the tibia (shin).


ITB friction syndrome has been described as a non-traumatic overuse injury, which is extremely common in runners. Injury to this structure in runners is most often due to:

  • Training errors: Generally when runners take on too much too soon, i.e. increasing their distance too quickly, doing more sessions than their bodies can handle and inadequate recovery periods between sessions can all contribute to pain at the ITB. New runners are particularly vulnerable to this as it is often easy to embark on a new running program without fully understanding the progressions.
  • Muscle imbalances in strength and flexibility: a common mistake in runners is the sole focus on improving their running, without focus on the strength and conditioning of the muscles and joints required. Adequate strength will give the joints stability which when running, which will reduce pressure on structures like the ITB. Recently researchers have discovered that poor conditioning of the hip musculature can increase an individual’s risk of developing ITB friction syndrome.
  • Surface and terrain: repetitive running on the same routes and surfaces with various cambers can cause alterations in an individual’s biomechanics, leading to imbalances.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions. Wearing adequate footwear will enable the foot to function more effectively reducing the impact on the more proximal structures.


  • Initially the pain is of gradual onset; often not sever enough to notice, which often goes ignored. Around the outside of the knee can become tender and may be warm and swollen.
  • The pain is typically described as coming on at a specific distance or time during a run.
  • Pain can increase when running down hill, coming down stairs and with any repeated flexion and extension exercise of the knee.


Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the ITB. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the hip, and core musculature is essential to reduce the pressure of the ITB.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with ITB pain, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

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