Iliotibial Band Syndrome

August 13th, 2022

Iliotibal Band (ITB)

  • band of connective tissue, located on lateral (outer) side of upper leg, crosses knee and attaches to tibia (bone of lower leg) just below knee
  • Tensor Fasciae Latae (TFL), Gluteus Maximus, and Gluteus Medius muscles form buttock, overlay hip, and insert into ITB
  • TFL/ITB act together to control side sway of pelvis and stabilize hip in erect posture; also to support knee laterally when leg extended

Iliotibial band Syndrome

  • ITB syndrome develops when TFL and Glut Max and Min weaken and TFL/ITB tissues tighten resulting in friction irritation between moving tissue and underlying bone of femoral condyle at knee (friction may also occur at outer aspect of hip, or greater trochanter, in related condition called Trochanteric Bursitis); genu varum (bow legs), excess internal rotation of tibia, and foot-ankle overpronation are other possible causes
  • onset of condition usually running-related, often attributable to training errors (e.g., over-training, faulty biomechanics, sudden or excessive increase in mileage or hill running, unsuitable shoes, running on severely cambered or crowned road surface)
  • pain often felt at outer side of knee and upper leg (often reported on examination when lateral side of knee palpated), worse with running (as run progresses), and grades (incl down hills); gluteal (buttock) trigger points may be identified
  • competitive runner may be in process of increasing mileage (possibly involving variation in road surface contour) when symptoms begin; may be difficult to convince runner to reduce mileage and avoid hills (esp down) and cambers
  • audible 'snapping' localized at hip or knee is produced as tensioned ITB rides over trochanter (hip bone) or femoral condyle (at knee) with repetitive hip and knee flexion and extension

Physical Therapy Treatment

  • application of electrotherapeutic modalities and ice to address inflammation and swelling (+/-bursa)
  • suggested training modifications (duration and pacing, hills, stride length, running surface); respect pain
  • footwear assessed (important to wear supportive shoes in good condition – replace regularly)
  • orthotics may be prescribed (to address foot-ankle pronation that can produce torsion stress at knee)
  • pelvic alignment assessed and corrected, as indicated
  • hip abductor strengthening and stretches (ITB, Gluteals, Piriformis, Quads, & Hamstrings) assigned (entire hip complex may be weak and tight), ongoing maintenance/preventive exercise routine
  • positional taping of the patella (kneecap) may be helpful

Other Treatments

  • anti-inflammatory and analgesic meds
  • acupuncture or dry needling


  • excellent prognosis with treatment and maintenance exercise routine

Physio Note: Gait Assessment

This condition is nearly always limited to one side and suggests asymmetry of gait and running patterns. Have your gait observed by running partners and/or analyzed by your physical therapist. Varying runs involving hills and road cambers can really help