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ITB Syndrome

Iliotibial band (ITB) pain is an overuse injury, most often caused by an increase in lower limb training load. There is a misconception that ITB pain is caused by friction of the ITB moving over the outer surface of the thigh bone. However, recent studies have shown that due to the significant attachments of the ITB, friction does not actually occur and pain is due to a compression of the tissue between the ITB and femur.


Runners are most commonly affected, with ITB pain making up 5-14% of running-related injuries. It is more commonly seen in male runners (50-81% of runners with ITB pain); runners who rapidly increase training volume; and runners who have a narrow step width or run with increased hip adduction.


  • Sharp knee pain, localised over the outer aspect of the knee

  • Reproduced during combined hip extension and knee flexion, commonly during downhill running or descending stairs

  • Associated hip weakness


Whilst pain generally makes us want to cease aggravating activities completely, this is not always the most suitable management, as patients will lose further ability to manage running loads. Once pain is gone and a runner returns to running, the increase in training load will generally recreate previous symptoms, creating a vicious cycle.

The overall strategy is to initially reduce running-specific loads and then progressively increase loads to overload the ITB and restore its tolerance to such loads.

Rehab programs must include:

  1. Heavy, slow resistance training

  2. Plyometric exercises

  3. Graduated return-to-run program

What not to do:

Foam rolling is commonly used to "massage" the ITB. Unfortunately, it is NOT a recommended treatment tool as it has been found that:

  • Flexibility changes aren't likely to last more that a few minutes

  • Any pain relief achieved from a foam rolling session is likely to be only temporary

  • Foam rolling does NOT release or "break up" adhesions

Most importantly, as ITB pain is a compression injury, adding further compression to affected tissues will only increase symptoms and/or reduce healing time.

If you have ITB pain or similar symptoms, book an appointment with one of our physios today for an assessment and appropriate rehab program.

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