ITB Friction Syndrome

The Ilio-tibial band or ITB is a thick tendon that crosses two joints. It extends from above the lateral hip joint to below the lateral knee joint. It commonly becomes tight in runners and during the constant bending and straightening of the knee during running gait it can rub and cause friction on the outside of the knee joint. When the knee bends to approximately 30 degrees (which is the average angle of the joint when the foot strikes the ground during running gait), it is most prone to compression of the ITB just above its insertion point. This contributes to inflammation, pain and even degenerative change in its structure.


The hallmark of ITB pain is lateral knee pain that comes on after a certain distance of running. The distance required to feel pain tends to get less and less with subsequent runs. Pain presents on the femur (thigh bone) just above the outside of the knee joint and can be dull or sharp. Knee flexion during running (especially running downhills) and squatting are usually the most aggravating movements and pain will normally worsen by continuing to run. It is normally tender to palpate at the site of pain on the outside of the knee and there may sometimes be swelling at this point.


Like most running injuries ITB friction syndrome can develop due to several different causative factors which are normally related to poor running biomechanics. These include tightness of the muscles around the knee including the hamstrings, quadriceps, calves and ITB itself, weakness of the gluteals/hip stabilising structures and excessive pronation at the foot.  Other environmental factors which may lead to this injury are unaccustomed training loads including excessive hill running (especially down hills), increased mileage, intensity, wearing poorly fitted or worn out footwear and change of training surfaces.

Prevention and Treatment

Initial treatment of this syndrome must involve de-loading of the IT band to allow pain and inflammation to settle so decreasing your training load for a period is essential.  Anti-inflammatory medication and icing may help to relieve acute pain as well as soft tissue therapy to release the excessive muscle tension through the band and surrounding musculature. Research shows that corticosteroid injections are not always helpful but are more likely to help in the early stages of the condition.

Identification of the causative factors and addressing these issues is very important for long-term management and prevention, so it is always best to see a professional to assist you with this. The Front Runner physiotherapists are experts in managing this condition and will help get you back running as soon as possible.

The best means of prevention is to ensure your running biomechanics are optimised by including regular hip strengthening and core stability in your training routine, regularly stretching and foam rolling (especially the ITB) after training sessions, avoiding over-training and ensuring you have properly fitted footwear which is updated regularly.


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