Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) is an overuse injury that describes damage to, and inflammation of, the iliotibial band (ITB) where it crosses the outside of the knee. It is also known as iliotibial friction syndrome. The iliotibial band is a long thick band of connective tissue (fascia) that runs down the outside of the hip, from the area of the hip and buttock, down to the bottom of the femur (thigh bone) and the top of the tibia (shin bone) on the outside of the leg. Every time you take a step, the ITB moves across a bony bump on the outside of the knee called the femoral condyle. This is the point at which the damage tends to occur. ITBS causes knee pain and is one of the most common causes of Runner’s Knee (patellofemoral pain syndrome), in which ITB tightness can cause the patella (kneecap) to mistrack and move out of alignment, causing pain and damage to the knee structures.  

What causes ITBS?

The painful symptoms from ITBS develop as a result of friction from the ITB rubbing against the outside of the knee joint at the femoral condyle, causing damage and inflammation. This typically occurs in activities involving repetitive movement of the ITB that involve the bending of the knee, such as running. Contributing factors include:
  • Having a tight iliotibial band
  • Weakness in the hip and core muscles, especially the quadriceps and gluteus medius
  • Flat feet (pronation)
  • Poor foot biomechanics
  • Differences in limb length
  • Improper running technique
  • Unsupportive joggers
  • Training on hills

What are the symptoms?

The primary symptom of ITBS is pain on the outside of the knee that is aggravated by running and movements where the knee is bent and straightened repeatedly. Other symptoms may include:
  • Tenderness or burning on the outside of the knee
  • Swelling
  • Pain on bending the knee 30 – 45 degrees
  • Pain may radiate into the thigh or calves
  • Pain alleviated by rest but may resume with activity

How is it treated?

The initial focus on treatment is to reduce the painful symptoms and allow the ITB to heal. Resting, ice and anti-inflammatories can help achieve this, and will stop the damage from worsening which means a longer recovery time. Once the symptoms have settled, treatment focuses on addressing the cause of the ITBS to stop it from happening again. Your podiatrist will carry out a thorough biomechanical assessment to identify the contributing causes to your ITBS. From here, a treatment plan will be made based on your results and findings. This may include:
  • Orthotics to help correct alignment issues at the feet and legs, and reduce the strain on the ITB
  • Gait retraining to work on running technique
  • Assessing footwear to ensure it is helping and not hindering your recovery
  • Strengthening weak muscles
  • Stretching tight muscles, especially the ITB itself where needed
  • Modifying training techniques and schedule