Iliotibial band syndrome

Iliotibial band syndrome ( ITBS) is an overuse injury that commonly affects sports people, particularly those that run,  who complain of pain that starts on the outside of their knee or knees. 

Traditionally the pain was considered to be due to friction between the ITB and the underlying lateral epicondyle of the femur (thigh bone), however more recent studies suggest instead of inflammation of a bursa in that area, it is more likely due to compression of a highly innervated and vascularised fat pad and connective tissue that causes the pain.

Typically a person will complain of the onset of pain at about the same distance or time during activity. There is local tenderness and often swelling with a burning sensation along points down the outside of the thigh.

Identifying the causes of ITB problems can be complex as it can be due to several factors above and below the area of pain. Ideally a physiotherapist is placed to assess the drivers causing the pain and advise the sufferer accordingly. These may include muscle weakness around the hip and/ or altered foot biomechanics.

Many people try painful self- treatments such as foam rollers to release tension and try stretching the tissue. 

An important fact to consider is you cannot stretch the ITB itself, it inserts along the length of the femur, but you can stretch the tensor fascia lata and gluteus maximus muscle which inserts into the ITB. The presence of trigger points in the muscles can be addressed and muscle strengthening exercises are an important component of treatment. Gait retraining and a graded return to running are also important strategies to consider.

Seek help from a professional who will aim to identify the causes of the pain and set you on the road to recovery. Runners always want to run!

Anatomy of the iliotibial band insertion


Cheryl Boettger, MCSP, Physiotherapist

Boyd Physiotherapy Associates