Iliotibial band friction syndrome

What is iliotibial band friction syndrome (ITBFS)?

Iliotibial band friction syndrome is a very common running injury.

The iliotibial band (ITB) is a very thick band of fascial tissue running down the outside of the leg from the hip to the knee. It is NOT a muscle and so the tissue behaves very differently. It does, however, have muscles that connect with it and other structures near it. As the name suggests this condition is thought to involve friction around the outside of the knee between the ITB and the surrounding structures. Increased pressure leads to inflammation and sensitivity of the tissues which builds up over time.

How does it present?

ITBFS causes pain on the outside of the knee. It can start as a dull ache but can build to a sharp, stabbing pain. The pain commonly develops in runners and can gradually start to develop earlier and earlier into runs. It also eventually takes longer and longer to settle and the affected knee will become very stiff and sore to move after the run and into the next day. At it’s worst it is not possible to run through the pain.

How is it treated?

‘Tightness’ of the ITB is often considered to be the main cause of pain but this is NOT the case. The ITB is an extremely thick, strong band of tissue and it is simply not possible to ‘stretch’ it or lengthen it. We can, however, decrease sensitivity of the area by targeting lower limb mechanics i.e. the way in which the knee copes when subjected to forces. Commonly in runners with ITBFS we tend to see a struggle to control the thigh bone as the foot lands on the floor. The knee can be seen to drop across the mid-line. This is sometime due to poor strength and control around the glutes and hip. Some runners present with a cross over running style which is also a risk for the development of this condition. Training error and footwear can also play a role.

You may have been given some foam rolling work to do which in the short term seemed to help but unless the above factors are addressed the condition will persist. It is not one of those injuries you can run through and ignore and in the long term the tissue around the outside of the knee can become thickened as it struggles to cope with the constant stress it is subjected to.

Treatment will involve easing pain through modified rest and other techniques such as taping. Addressing movement patterns and strength through the lower limb can then begin before analysing running style and training patterns.

What You Need To Know
  • Common running injury.
  • Will cause focal pain around the outside of the knee.
  • Foam rolling may help in the short term but it will NOT cure the condition.
  • Strength and movement control through the hip and knee is essential to treat this injury.