ITB Pain: Ilio-Tibial Band Syndrome 🏃‍♀️🏃

The Iliotibial Band (ITB) is a thickened band of connective tissue running from your pelvis to the outside of your knee. It is an incredibly strong and resilient structure – one of the strongest in the human body!

However, it can cause discomfort on the outside portion of your knee. Runners; endurance athletes and cyclists often experience discomfort due to ITB related pain. It is an overuse injury meaning the ITB is placed under more load than it can handle; this can be caused by a number of factors.

But, first what is the mechanism behind this pain or discomfort? The below diagram illustrates.

ITB Pain Mechanism

Causes of ITB Related Pain

1. Muscle Weakness and Fatigue: The gluteal muscles (Glute Max, Med and Min) are responsible for limiting the inward rotation of the femur. Weakness of these muscles will increase the amount of inward rotation of the femur resulting in the ITB working overtime to stop this rotation.

2. Training Errors: As outlined in the pie chart. A spike in duration; frequency; distance or intensity of your runs can quickly lead to ITB related pain. Uneven terrain; ill-fitting shoes or a spike in hill training can also contribute toward ITB Syndrome.

3. Running Pattern: A narrow running gait, as shown on the right, means the ITB is placed under more strain and therefore further compresses the underlying connective tissue onto the bone.

Signs and Symptoms of ITB Syndrome

  • Sharp pain on outer aspect of knee.

  • Walking downstairs or downhill running aggravates pain.

  • Long distance running/cycling aggravates pain.

  • Tenderness on outer aspect of knee with palpation.

What Works and What Doesn’t? ✅ ❌

Strengthening Exercises: Consistent strengthening of the entire kinetic lower limb chain is recommended for endurance athletes, but focus should be emphasized on strengthening gluteal muscles.

Dry Needling: Often trigger points will develop in muscles implicated with ITB related pain. Dry needling aimed at these trigger points will reduce muscle tension on the ITB.

Strapping: Offloading the ITB and underlying tissue with the use of strapping will assist in bringing your pain down dramatically.

Shockwave Therapy: At CMP Inc we offer Extracorporeal Shockwave Therapy with many of our patients having great success with this form of treatment.

Cross Training: Swimming is a fantastic low impact sport to maintain your level of fitness and to prevent aggravating your knee in the initial stages of injury. Activity modification in the initial stages of injury is required to help calm down all your signs and symptoms.

Foam Rolling: DO NOT FOAM ROLL YOUR ITB!!! Many of my patients ask me should I be foam rolling my ITB. All you’re doing here is further compressing the underlying tissue which is what is causing your pain in the first place!? Rather foam roll your gluteal and tensor fascia latae muscles.

Stretching: DO NOT STRETCH YOUR ITB!!! You are not making any difference to the length of it. It is an incredibly robust ligamentous and tendinous structure. The common stretches I see being performed have minuscule changes in terms of ITB length. To see significant length changes you would need to generate forces out of your own control.

This is a common condition we treat at Christiaan Moolman Physiotherapy Inc. We have achieved great success with our patients rehabbing them back to their everyday activities with a spring in their step… quite literally.

Book your appointment now with Christiaan Moolman Physiotherapy Inc. at E-MedCentre and together let’s get back on the track!

Call us on 082 459 5573 or book your appointment online via our website at

Disclaimer: The information provided should serve as a guideline only. Please consult your Physiotherapist at Christiaan Moolman Physiotherapy Inc. if you are uncertain about your injury and extent thereof. CMP Inc will not be held liable for any injuries sustained.


1. Brukner, P., Khan K, et al. (2017). Brukner and Khan’s Clinical Sports Medicine (McGraw-Hill, North Ryde, NSW).

2. Filley, A. (2021). Iliotibial band syndrome: compression or friction?

3. Lavine R. Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine, 2010; 3(1-4) :18–22

4. Lazenby, T & Geisler, P (2017). Iliotibial Band Impingement Syndrome: An Updated Evidence-Informed Clinical Paradigm. Published 2017/03/06.

5. van der Worp MP, van der Horst N, de Wijer A, Backx FJ, Nijhuis-van der Sanden MW. Iliotibial Band Syndrome in Runners. Sport Medicine, 2012; 42(11):969-92.

6. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport, 2007; 10:74-76.

7. Weckström K, Söderström J. Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome, Journal of Back and Musculoskeletal Rehabilitation, 2016; 29(1):161-70.

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