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ITB Syndrome

If you’ve ever experienced Iliotibial band friction syndrome (ITB) it is likely an experience you have not forgotten. The pain is a very sharp disabling pain and usually comes on when you’re at mile 6 of your 12 mile run, the day you decide to run down a deserted country road looking for solitude. The problem is that the pain is SO bad that often you cannot take another step. The pain is felt at the outside or lateral side of the knee.

The ITB is not a muscle. It is a thick band of tissue called fascia that starts on the outside of the hip, passes down the outside of the thigh and inserts into the side of the patella (knee cap) and the tibia, (shin bone).  As well as arising from the iliac crest (hip bone) the ITB attaches into the gluteal muscles at the back and tensor facia lata muscle at the front.

Iliotibial band friction syndrome is due to an inflammatory response from dysfunctional repetitive movement of the ITB.  When we bend and straighten the knee this band passes over the lateral femoral condyle of the knee. If it is inflamed it becomes very painful during this movement. 


  • Too much too soon!
  • Not adhering to the 10% rule for weekly mileage and long runs.
  • Poor training surface i.e. crowned roads.
  • Improper footwear or recent change in footwear.
  • Sudden exposure to hill running.
  • An inappropriate increase in speed or mileage.
  • Pelvic imbalances including weakness of the hip abductors, dominance of the gluteal muscles.
  • Poor flexibility of lower extremity muscles.
  • Tight piriformis and gluteal muscles.


Very prevalent in runners, more frequently in males. As high as 12% incidence of all running related overuse injuries.


Catch it early! If you feel discomfort on the outside of the knee when walking, running, going up stairs, etc. get it checked out! A little test you can do on yourself is to see if the pain decreases or goes away if you walk with a stiff legged gait. If it does, you likely have this syndrome.

Treatment – Seek Professional help!

  • Ice to decrease inflammation. At least 4 times per day for 10 minute intervals.
  • Relative rest! Alternate running with another activity to prevent further tissue damage and also achieve a training effect. i.e. elliptical trainer/swimming
  • Modification of the intensity of training session.
  • Stretching exercises to increase the flexibility of the piriformis muscle gluteal muscles and Iliotibial band.
  • Physiotherapy treatment may be useful to decrease inflammation and pain, to determine the cause, treat the problem, prevent reoccurrence and advise regarding treatments listed.
  • Control the excessive pronation with an orthotics if needed or change your footwear. Select PROPER shoes for your foot type. Change shoes every 300 – 400 miles. For high mileage runners alternate between 2 pairs of shoes to allow “shoe recovery”.
  • Avoid training on uneven surfaces.
  • Foam roller.
  • Strengthening exercises


  • Stretches must be done slowly and gradually.  NO BOUNCING!
  • Hold the stretch 15-90 seconds.
  • Repeat five times or more each stretch.
  • Stretch often, especially before and after activity.
  • Stretch both legs.

Piriformis Stretch

Lie on your back. Straighten your right leg. Bring your left knee toward your right shoulder using your left hand. Then use your right hand and bring your left ankle toward your right shoulder. You should feel the stretch in your left buttock.

Iilotibial Band Stretch

Standing with your left leg crossed behind your right leg. Side bend your upper body to the right. Feel the stretch on the left side of your leg and hip. This stretch can be a bit more difficult to feel and you may have to adjust your position slightly.


Once the acute painful stage has subsided, strengthening can be added in a controlled and graduated fashion.  Start with 3 sets of 5 repetitions and progress to 3 sets of 20 repetitions with increasing resistance with weights or theraband tubing.

  • Side Lying Abduction


  • Side Lying 'Clamshells'




I love the gluteal strengthening exercises in this article. The importance of gluteal strengthening and core stability cannot be stressed enough. Consistency is the key to success!

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