Iliotibial band Syndrome

Iliotibial Band Syndrome

What is it?

The Iliotibial Band (ITB) runs from the Tensor Fascia Latae (TFL) from the outside of the hip down the outside of the thigh and attaches just below the knee on the tibia. It is most active at 20 – 30 degrees knee flexion (this is the knee range that can be irritated). ITB Syndrome is an overuse injury of this connective tissue, which is common especially in distance runners. The pain is usually experienced either on the outside of the knee or outside of the hip.


Iliotibial band is a connective tissue structure. Together with the associated muscles, it assists in extension, abduction and rotation for the hip. It is also a lateral (outside) knee stabiliser.

iliotibial band syndrome

My personal experience

Training for my first Comrades Marathon put a huge toll on my poor body. At the time I wasn’t regularly doing strength exercises and I found with the increased mileage, my left ITB started to flare up. I mainly felt it after my long runs. I would experience a dull ache from my left hip down my thigh. My ITB pain was predominantly by my hip/ gluts area while the majority of people usually experience pain on the outside of the knee.

What did I do?

Well, I carried on running. Why? Because I was able to monitor and treat my symptoms enough that I didn’t experience any discomfort during my runs. I made good use of my physio husband who needled extensively – especially the gluts and thigh area – and I feel that this, together with foam rolling and gluts strengthening that I started – allowed me to continue running and not experience pain. I ran my Comrades completely comfortable (well, no ITB pain!!).

iliotibial band syndrome

The Role of the Running Shoe

Grant Bryant

I spoke with Grant who is a “shoe geek”, “owner-of-too-many-shoes” and works in Run Store , Cape Town…. and he had this to say about the role of running shoes related to ITB Syndrome:

A high proportion of the time, a stability (anti – pronation) shoe will cause ITB if the shoe is not specifically required. Obviously, we must not look at shoes in isolation. Glut strength, hip/ leg length and other factors also play a role as well as training errors, road camber etc.

iliotibial band syndrome

Iliotibial Band Syndrome

Possible Causes

There are a number of contributing factors for this frustrating condition.

Run Gear/ Training Errors:
  • Overstriding (foot strike too far forward when running)
  • Crossing over (feet cross over the midline when running)
  • Road Camber (large angle of the road)
  • Incorrect Shoes (as discussed above)
  • Rapid increase in training load
  • Pelvis uneven (not able to maintain pelvis neutral)
  • Gluts med weakness
  • Leg length difference
  • Quads/ Hamstrings decreased strength/ poor flexibility (these muscles work closely with the ITB)
  • Poor Core Strength
Not to be missed:
  • Referred pain from the back or hip
  • Localised spasm
  • Bruising (hitting your leg on the side of that coffee table!)

Treatment advice

If you are able to address the underlying cause early, you will more likely be able to manage and resolve this condition. Here are some ways to treat ITB Syndrome, HOWEVER, you NEED to have a thorough assessment done by a Physiotherapist in order to effectively treat ITB Syndrome.

  • A Running Assessment is a great way to analyse how you run. To see if there are any biomechanical errors. Assess muscle length and strengths.
  • Ensure your quads/ hamstrings have good length and strength. Also, hip flexors. Especially if you sit for prolonged periods of time.
  • Work on your core exercises
  • Run on even road – not on the camber (side of the road)
  • If you run trail and your ITB is irritated in particular with trail running, try road running for a short period until it settles down.
  • It is an overuse injury. Look at your training load and adjust accordingly.
  • If your pain is by your knee, you may have irritated the bursa (a fluid filled sac which prevents friction). Ice and relative rest is the best. NOT massaging it! This is why a thorough assessment is important to be able to distinguish between the bursa irritation or just ITB pain only.
  • There is conflicting advice and evidence about Corticosteroid injections. There is a place for them. However, this should be after an assessment and all advice then can be specifically given.
  • Foam rolling – may be of benefit for the quads and hamstrings in particular. The ITB can also be foam rolled, however it takes longer to “lengthen” if it even does! Again, in the research there are varying opinions with this.
  • Medication – may be of benefit to reduce the inflammation and pain, if needed.
iliotibial band syndrome

In Conclusion

The Bottom Line

  • Catch it early
  • Get a holistic assessment in order to get the best treatment
  • A running assessment (especially if this is the time you experience the pain) may be of benefit
  • Correct any training errors
  • Adapt and adjust
  • Have a return – to – running strategy. Do not continue where you left off!

Your say

What have you found that works to relieve ITB pain? Are there any other suggestions that you can recommend?