What is ITB Syndrome?
Iliotibial Band (ITB) Syndrome is a condition that results in pain on the outer side of the knee, often experienced by athletes who engage in repetitive activities like running or cycling. The ITB is a thick band of connective tissue that runs along the outside of the thigh, from the hip to the shin, and plays a critical role in stabilizing the knee during movement. The ITB is an extension of the tensor fascia latae, gluteus medius, and gluteus maximus.
When the ITB becomes tight or irritated, it can lead to friction between the band and the lateral epicondyle of the femur. This friction can cause inflammation, resulting in lateral knee pain, particularly with activities that involve repetitive periods of knee flexion and extension, like running or cycling.
The ITB is in contact with the lateral epicondyle at about 30 degrees of knee flexion—which is around the angle your knee makes when your foot strikes the ground while running or cycling. This is known as the ‘impingement zone,’ and this is why activities that involve repetitive knee flexion can trigger ITB Syndrome.
Symptoms of ITB Syndrome:
Pain on the outside of the knee
The pain gets worse with activity—the more you run or cycle
Pain may radiate up or down the thigh and shin
Clicking or popping sensation
How is ITB syndrome treated?
Fortunately, most cases do really well with conservative management, and patients will have a complete resolution of symptoms within 6-8 weeks. A combination of the following approaches is often recommended to manage and alleviate symptoms:
Manual therapy to loosen the muscle attachments to the ITB (glutes, TFL)
Strengthening of the hip abductors
Gradual return to activity
Return to running:
Gradual return to running on a flat surface
Run at a relatively fast pace—don’t try to return to running at a slow pace
Avoid downhill running
Running on a flat surface and at a fast pace has been shown to reduce time spent in the impingement zone- the time that the ITB is in contact with the lateral femoral epicondyle.
Examples of exercises to strengthen hip abductors:
Side-lying hip abduction holds
Side-lying leg lifts
Modified side plank + leg lifts
Banded crab walks
Single-leg squats
Banded glute bridges
If this sounds like you, book in with a trusted physiotherapist at Lilydale or Healesville Physio & Sports Medicine for an individualised treatment plan.
Example photos of exercises to strengthen hip abductors:
Eg. Side-lying hip abduction holds
Eg. Side-lying leg lifts
Eg. Modified side plank + leg lifts
Eg. Banded crab walks
Eg. Single-leg squats
Eg. Banded glute bridges
References:
Hadeed, A., & Tapscott, D. C. (2019). Iliotibial band friction syndrome.
Balachandar, V., Hampton, M., Riaz, O., & Woods, S. (2019). Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscles, Ligaments & Tendons Journal (MLTJ), 9(2).