Ilotibial Band Syndrome (ITBS)

Ilotibial Band Syndrome (ITBS) is one of the leading causes of knee pain in runners, typically experienced on the outside or ‘lateral’ aspect of the knee. However ITBS is not exclusive to runners and can be experienced by many people of a variety of ages, causing significant discomfort during walking or standing.

The iliotibial band (ITB) is a superficial thickening of tissue on the outside of the thigh extending from the outside of the pelvis, over the hip down to the outside of the knee, and ending just below the knee joint. The band plays a crucial role in stabilising the knee during movement of the hip and knee, which takes place as the band roles over the top of the thigh bone (femur) during movement, and as muscles surrounding it contract.

In cases where the band has shortened becoming tight, or the muscles around have weakened, this continual rolling of the band over the outside bone of your hip (lateral femoral condyle) combined with the repeated knee motion, during activities such as walking or running, may cause the ITB, or parts of the band to become inflamed and painful.

Signs and symptoms

ITBS symptoms range from a stinging sensation just above the knee joint to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present above and below the knee, where the ITB actually attaches to the tibia.

ITBS can result from one or more of the following biomechanical problems, muscular imbalances, or exercise training habits.

Biomechanical problems

  • High or low arches 
  • Supination of the foot (rolling in of the forefoot and arch causing a tightening the ITB)
  • Excessive lower leg rotation 
  • The force at the knee when the foot strikes 
  • Uneven leg length
  • Bowlegs or tightness about the iliotibial band
  • Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator.

Muscle imbalances 

  • Weak hip abductor muscles (particularly Gluteus Medius)
  • Poor core stability
  • Poor muscle control around the knee cap (VMO) causing problems with the tracking of the knee cap over the knee when walking or running, relative to the ITB.

Training habits 

  • Always running on a banked surface (such as the shoulder of a road or an indoor track) 
  • Excessive up-hill and down-hill running
  • When cycling having the feet "toed-in" to an excessive angle 
  • Running up and down stairs
  • Hiking long distances 
  • Poor rowing technique
  • Poor breaststroke technique.

How physiotherapy can help

While ITBS pain can be acute, the iliotibial band can be Rested, Iced, Compressed and Elevated (RICE) to reduce pain and inflammation, followed by stretching, which your therapist can show you the correct techniques for. Using a foam roller to loosen the iliotibial band through deep tissue massage, can help prevent and treat ITBS (your therapist can discuss this with you).

Other treatment options include acupuncture of the ITB to help relax the tissue and improve blood supply; this is also beneficial if your problem is long standing (chronic) and you have developed ‘trigger points’, or painful knots in the ITB.

Taping has also been shown to help with ITBS through restoring control around the knee. Physiotherapists use a taping technique for the knee cap (patella taping) to improve the mechanics or use Kinesio taping of the ITB.

Other treatments available for this injury include a compression wrap to mobilise the ITB where the tendon meets the knee. This is called an 'IT band compression wrap.' These are all treatment options that your therapist may discuss with you to tailor the treatment to suit your needs.