Iliotibial band syndrome (ITBS), or iliotibial band friction syndrome, is a common and often persistent knee injury that causes pain on the outside of the knee. 

 ITBS is an overuse injury caused by repetitive movements and is frequently seen in runners and cyclists. 

ITBS is generally managed conservatively with physiotherapy and temporary modification to some activities.

What Is The Iliotibial Band?

The iliotibial band (aka ITB) is a long band of fascia which runs along the outside of the thigh. 

It connects from the tensor fascia latae and gluteus maximus muscles at the hip, descending down the thigh to insert on the tibia, crossing both the hip and knee joints. 

The iliotibial band is an important structure in stabilising the outside of the knee as the joint flexes and extends.

What Is Iliotibial Band Syndrome (ITBS)?

ITBS is a condition caused by the friction of the ITB moving across tissues and structures on the outside of the thigh.

When the knee bends, the ITB moves back over a bony ridge of the thigh bone (femur). It then passes over this again as it moves forward during knee straightening. 

Repetitive bending and straightening of the knee can result in the ITB becoming inflamed, irritated and painful.

ITBS discomfort typically arises from:

  • Abnormal contact between the ITB and femur
  • Poor alignment  or muscular control of the leg
  • Prolonged friction forces during repetitive activities

ITBS can occur in people from all walks of life, it is most often seen in:

  • athletic individuals performing repetitive activities, such as: squatting, running and cycling
  • individuals who spend periods in prolonged positions, such as: sitting, standing, climbing, squatting, or kneeling throughout a long workday
  • individuals who suddenly increase or start a new exercise regime

Signs And Symptoms

With ITBS, you may experience:

  • Sharp or burning pain on the outside of the knee
  • A ‘snapping’ sensation over the knee as it bends and straightens
  • Swelling around the outside of your knee
  • Activity related pain, eg. with running over a long distance or down hill
  • Continuous pain following activity
  • Occasionally, tightness and pain on the outside of the hip

Pain is usually most intense when the knee is in a slightly bent position, either right before or right after the heel strikes the floor. This is the point where the ITB rubs the most over the femur.

 

How Is It Diagnosed?

Your physiotherapist will ask questions and complete a physical examination to provide information on the way that you move and how it might contribute to your injury. 

Generally, medical imaging tests such as X-ray or MRI, are not needed to diagnosis ITBS.

How Can A Physiotherapist Help?

Your physiotherapist will use treatments including:

  • Rest  and activity modification – to prevent further aggravation of injury
  • Ice or heat
  • Anti-inflammatories
  • Ultrasound therapy
  • Massage
  • Foam rolling
  • Trigger point release
  • Stretching exercises – to stretch ITB and related structures
  • Strengthening exercises – to address any muscle weakness

 

Home Exercises

ITB Stretch:
Standing upright, cross the affected leg behind the opposite leg
Lean to the unaffected side until you feel a stretch across the affected ITB
Hold for 30 seconds

Foam Rolling

Foam rolling can be used as a recovery and maintenance to promote soft tissue release and extensibility.

When foam rolling, it is generally recommended to slowly roll the desired area for 30-60 second bouts, working in small portions rather than rolling in large sweeping motions.

ITB: roll on the outside of your thigh, breaking it up into three sections.

Tensor Fascia Latae: on your side, roll slightly to the front of your hip bone.

Gluteals: roll sitting on the foam roller, crossing one leg over the other.

Want to learn more about other types of knee pain? Read our other blogs here:

Patellar Tendinopathy

Patellofemoral Pain Syndrome

Meniscus Tears