22 March 2021

Iliotibial band syndrome

Iliotibial band syndrome (ITBS) is the second most common knee injury, and is usually associated with long distance running, cycling and weight-lifting.

In this article you will get som info about it, and also some tips and advices how to prevent it, and how to stretch and reduce the stiffness. Check out my personally recorded video in the end of the article!

What is ITBS?

Iliotibial band syndrome (ITBS) is the second most common knee injury caused by inflammation located on the lateral aspect of the knee due to friction between the iliotibial band and the lateral epicondyle on the femur. Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. Risk factors in women include increased hip adduction, knee internal rotation. Risk factors seen in men are increased hip internal rotation and knee adduction. ITBS syndrome is most associated with long distance running, cycling, weight-lifting, and with military training.

The etiology of ITBS is often multifactorial. Long distance running is a common cause of ITBS, especially if running on slightly banked ground, as the subtle drop of the outside of the foot stretches the ITB, increasing the risk of injury, Sudden increases in activity levels can also lead to ITBS. Although repeated tissue compression leading to irritation is best supported by recent evidence, there are a number of other trains of thought regarding the evolution of this condition.

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity. The continual rubbing of the band over the lateral femoral epicondyle combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Muscle weakness of the hip abductors is also be associated with iliotibial band syndrome as this causes increased hip internal rotation and knee adduction. This was found as a significant issue for athletes with iliotibial band syndrome.  Another proposed etiology is chronic inflammation of the ITB bursa.

You need to understand the importance of strength exercises and muscle strengthening. Weaknesses of muscles when running lead to injuries of those same, or muscles related to them.

We all used to have a problem with an injury, of lesser or greater intensity. It is very important, if it is a minor pain, that you immediately start to solve the problem, and not wait for it to intensify and a bigger problem arises.

The iliotibial tract also contains the muscles of the buttocks, both large and medium (gluteus maximus et gluteus medius), and as the m.gluteus maximus is the strongest, and thus the most important muscle for moving the leg to the side and rotating the leg outward at the hip joint, is often its weakness the cause of this syndrome.

Pain may not occur immediately during activity, but may intensify over time. Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia.

Do not ignore the pain on the lateral side of the knee, especially if it is sharp and uncomfortable. This usually means that the ITB is inflamed.


The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment.

  • Rest, ice, compression, and elevation (RICE).
  • Anti-inflammatory medications, if questions or concerns exist, it is wise to ask a health care professional or pharmacist about their safe use.
  • Home treatment can involve stretching, massage and use of foam rollers at the site of pain and inflammation.
  • Should these first-line treatments not work, physical therapy may be needed to decrease the inflammation at the IT band. Some treatments focus on flexibility and stretching. Friction rubbing may occur over the IT band at the femoral epicondyle may help to break down inflammation and scarring.
  • Therapeutic ultrasound techniques may be used, including phonopheresis (ultrasound propels anti-inflammatory medications through the skin into the inflamed tissue) and iontophoresis (electricity is used instead of ultrasound) to help decrease irritation in the soft tissues surrounding the knee.
  • The physical therapist may also help evaluate the underlying cause of the problem and look at muscle strength and balance and/or flexibility and gait analysis (watching a person walk, run, or cycle). Shoe orthotics may be useful if there is a gait problem, pelvic tilt, or leg-length discrepancy as a potential cause of IT band syndrome.

And of course, it is best to do exercises that strengthen all the muscles and prevent the problem from happening.

In video you have exercises for strength and stretching.Don’t be confused by what the gluteus, piriformis, iliotibial tape says … it’s all connected, most of the exercises match or are similar. All muscles is connected ,and as we said,glutes must be strong.

These are some of the exercises for strengthening the muscles of the gluteus and legs, without weights, and a few examples of stretching. If you need more tips and suggestions for exercises, you can contact us on our instagram and facebook pages.

Best regards!

/Snezana Djuric, Arduua

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