Iliotibial Band Syndrome – Injury, Causes And Treatment

One of the most common causes of knee pain in runners is ITB friction syndrome (ITBS). It is a repetitive strain or overuse injury that is exacerbated by poor running biomechanics and muscular imbalances which cause the ITB to overwork and become very tight. 

What is the ITB?

The ITB is the iliotibial band. It is a long thick band of fibrous tissue that runs down the outside of the thigh from the hip to the knee. It starts from the outside of the pelvis at the top of the hip and attaches to the tibia (shin bone) on the outside of the knee. It has a role in stabilising both the hip and knee joint.

What are the main symptoms?

  • Burning or sharp pain on the outside of the knee
  • Pain worsens with running or repetitive high impact activity such as jumping
  • If left untreated, it can start to interfere with everyday activities such as walking, standing up from a chair, or going up and down stairs
  • There may be swelling on the outside of the knee

Common causes of ITBS

ITBS is caused by ITB sliding over the femur at the knee when the knee is bent, creating friction, inflammation and pain. There are many factors that can contribute to this.

Poor running biomechanics

Lack of arch control in your foot affects the way your hip and knee are aligned, placing greater stress on the ITB. Poor muscle strength in your hip and knee can cause the knees to roll inwards and also affect your alignment. Ensuring you have proper footwear with a good arch support can help prevent ITBS from developing. 

Changes in training load

A sudden increase in running distance, speed, or frequency of training can place excess stress on the ITB as it is not used to coping with the increased load. Changing your running surface or including more hills in your runs also results in a higher load placed through the ITB. As it is not able to cope, it fatigues quickly and affects the alignment of your hip and knee, causing inflammation and pain.

If you are looking to progress your training load, increase by 10% max each week, and only change one parameter at a time- whether that be distance, speed, or frequency. Ensure you have a rest day after long runs.

Muscle weakness

The ITB often becomes tight due to weakness in your glute muscles. If the glute muscles aren’t strong enough to cope with the demands of your activity, the ITB kicks in and does more than it should, causing it to become very tight. Poor control in your quadriceps muscles affects the knee position when the foot strikes the ground, resulting in greater stress on the ITB. It is important to strengthen your quads and glutes, as well as stretch the ITB to correct the muscle imbalance.

How can Physiotherapy help with ITBS?

Physiotherapy is very effective in treating ITBS. We identify the underlying cause and from there can work to treat the pain, inflammation, restore knee range of motion, and correct any muscle imbalances. A personalised exercise program will be developed to target the muscles that need to be strengthened, and the muscles that need to be stretched and have more flexibility. We can assess your running technique and give running gait and footwear advice as required. If necessary, we can fit you with orthotics to help provide more arch support to help improve the alignment of your knee. 

If you are suffering from pain on the outside of the knee, or would like some more information or advice, please give us a call on 98753760 or email We would be more than happy to help!

If you need physical therapy to relieve
your pain, and would like some more
information, feel free to contact us!

Give us a call on (02) 9875 3760 or email We would
be more than happy to help you.