Iliotibial Band Syndrome

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Clinically Relevant Anatomy

Iliotibial band syndrome is often referred to by other names, most commonly, runners knee and Iliotibial band friction syndrome, sometimes shortened to ITBS or ITBFS. All of these names refer to the same condition. The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). Its purpose is to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways).

As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.

Iliotibial band syndrome is common in runners as 20-30 degrees is the approximate angle at the knee when the foot strikes the ground during running. In persons who run regularly this may lead to irritation of the ITB commonly known as iliotibial band friction syndrome.


Certain factors may make you more susceptible to developing iliotibial band syndrome:

  • A naturally tight or wide IT band
  • Weak hip muscles such as gluteus medius
  • Trigger points within the IT band and gluteal muscles
  • Overpronation
  • Overuse
  • Excessive hill running
  • Running on a cambered surface
  • Leg length difference
  • Most of these factors can be addressed through changes to your training programme, the use of insoles or heel pads and a thorough rehabilitation programme. Iliotibial band friction syndrome may require long-term rehabilitation and frequent Iliotibial band stretches should be maintained even after symptoms cease.

Characteristics/Clinical presentation

  • Pain on the outside of the knee (at or around the lateral epicondyle of the femur).
  • Tightness in the iliotibial band (see assessment)
  • Pain normally aggravated by running, particularly downhill.
  • Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
  • Weakness in hip abduction.
  • Tender trigger points in the gluteal area may also be present.

Quick Diagnosis


  • H/o increased running distance/intensity/frequency.
  • Pain over lateral knee
Objective findings
  • Postivive Nobles compression test, positive Ober’s test.
  • Defferentaite from LCL sprain
  • Pes planus or genu varum can precipitate this symdrome.
  • Tenderness with palpation of the lateral femoral condyle.


General Advice for a patient:

  • Rest. Avoid painful stimuli, for example downhill running.
  • Use of a foam roller on ITB (but not over area of compression).
  • Self massage techniques can also be very helpful in correcting excessive ITB tightness.
  • See a sports injury specialist.


Health professional and Physiotherapy management:

  • Perform soft tissue or deep friction massage.
  • Prescribe anti-inflammatory medication such as NSAID’s e.g. Ibuprofen.
  • Use Myofascial release techniques which have been shown to be highly effective.
  • Perform dry-needling techniques.
  • Outline a rehabilitation strategy which may include stretches and exercises to strengthen the hip abductors.
  • Use electrotherapeutic treatment techniques such as TENS or ultrasound to reduce pain and inflammation.
  • In acute or prolonged cases a corticosteroid injection into the site of irritation may provide pain relief.


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