ITB Syndrome

By Sydney CBD Osteopath Dr Abbey Davidson

Lateral knee pain? Especially after running or cycling? You may be suffering from ITB syndrome or runners knee.

What is ITB syndrome? What causes it? What are the signs and symptoms? What to do if you have ITB syndrome? How will physio/osteo treat ITB syndrome? How long until ITB syndrome it better?

If reading this whole article isn’t your style, check out this short video with Dr Abbey Davidson (Osteopath):

What is ITB Syndrome?

Anatomy of the lateral thigh showing the ITB and its relationship to the glute and TFL muscles. Site of pain is at the knee despite these muscles being located at the hip.
Image Source: bodyheal

ITB or iliotibial friction syndrome is commonly referred to as runners knee. During activity, like running, the ITB will flicks over the femoral condyle (front to back) to stabilize the knee. ITB syndrome is where friction builds up by the repetitive rubbing of the ITB over the lateral femoral condyle.

The ITB or iliotibial band is a thick band of connective tissue or fascia (similar to a ligament) which is located on the lateral thigh. It runs from the iliac crest (hip bone) with the  gluteus maximus and tensor fascia latae (TFL) muscles attaching to it. The ITB inserts just below the lateral (outside) knee at the at the tibial condyle (shin bone). The ITB assists in hip extension, abduction and external rotation and also adds lateral stabilization to the knee joint.

Causes of ITB Syndrome:

ITB syndrome is a common injury which is caused by:

  • Over use/overtraining (repetition results in build-up of friction under the ITB -running, cycling, squatting, hiking are common activities associated with ITB syndrome)
  • Hip abductor weakness (weakness around the hips places more stress on the knee joint and stabilizers like the ITB)
  • Poor foot/hip/knee mechanics (the ITB passes the hip and knee joint hence poor mechanics at or around these joints can place extra stress on the iliotibial tract
  • Sudden changes in training habits (increased number or intensity of training sessions e.g. training for a marathon)
  • Change in training surface (e.g. from grass to concrete)
  • Poor training equipment/footwear (can alter mechanics at the foot/ankle and therefore the knee and knee stabilizers)

To avoid ITB syndrome it is important to avoid drastic changes in training habits, wear appropriate footwear

Signs and Symptoms of ITB Syndrome:

Common signs and symptoms of iliotibial band syndrome can include:

  • Pain outside/lateral knee and thigh
  • Aggravated during and after activity
  • Sensation of tightness (especially lateral thigh)
  • Swelling/redness

If you believe you may be suffering from ITB Syndrome get assessed by your physiotherapist or osteopath to begin your recovery.

What you can do right now for ITB Syndrome?

When suffering from ITB syndrome  you can rest, reduce inflammation (ice), stretching hip muscles and strengthening hip muscles.

Reducing inflammation especially after a period of use or exercise is important. Using an ice pack (avoiding direct skin contact) for 10-20 mins on 20 mins off can achieve this. Topical anti-inflammatory gel may also be an useful adjunct.

Rest plays an important role in recovering from ITB Syndrome. One of the main reason for friction under the ITB is over use. Decreasing your training frequency and intensity can provide the time your body needs to recover. Once the underlying cause of your ITB syndrome has been addressed you can progressively return to your desired activity level.

Stretching techniques like those demonstrated in the video at the top of page are important. Please note that you cannot stretch the ITB itself so firm massage or stretching will not be beneficial. Stretches and massage which target the muscles which insert into the ITB band (glute maximus and TFL)  can be effective.

While strengthening exercises which focus of the hip abductors (like your glutes) may not provide immediate relief; they can be crucial for addressing the underlying cause of your ITB syndrome. Stronger hip muscles will prevent extra stress being placed on the knee and knee stabilizers (like the ITB).  

Physio and osteo treatment for ITB Syndrome:

You physio or osteo will spend time taking a history of your complaint, assessing the region and establishing your diagnosis. They will spend time educating you about your ITB syndrome and explain your treatment plan going forward.

Hands-on techniques will focus on improving the surrounding joints range of motion, decreasing muscular tension, correcting mechanics, decreasing inflammation and pain levels. This will be complemented by care advice, stretches, exercises which the practitioner will give you. This will aim to improve your symptoms not only on the short-term but prevent re-injury in the future. They will aim to correct biomechanical patterns and strengthen weakened muscles.

Your physio or osteo will also over your return to sport/running. They will ensure that you progressively increasing the load in a way that avoids injuring your ITB again.

How long until ITB Syndrome gets better?

When following the advice of a health professional an ITB syndrome will usually respond within 6 weeks. However, this will depend on how long your knee pain has been present, your compliance to the treatment plan (resting and regular performance of prescribed exercises) and other medical conditions present.

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