ITB Syndrome

What is ITB syndrome?

Iliotibial (ITB) syndrome is a common cause of lateral knee pain in runners, with a prevalence as high as 17%. The ITB is a thick band of connective tissue which runs down the outside of the thigh. It’s role is to assist in stabilising the hip and knee during movement. ITB syndrome is an atraumatic overuse injury typically characterised by pain on the outside of the knee. It is often referred to as ITB friction syndrome, however more recent evidence suggests that this condition is the result of compression of the ITB on the femur when the knee is flexed.

Can I stretch my ITB?

The ITB cannot be stretched like other tissues such as muscle. The ITB is a thick band of connective tissue which plays an important role in stabilising the hip and knee, and transferring force from musculature. As such, it’s role would become redundant if it were able to be stretched out like muscle tissue. Studies demonstrate that foam rolling and stretching does not impact on ITB stiffness.

What are the risk factors for ITB syndrome?

Risk factors for ITB syndrome include: 

• Biomechanics (i.e., narrow step width, increased hip adduction in stance, increased step length, decreased lumbopelvic control)
• Decreased hip abductor strength
• Significant leg length discrepancy

• High training load
• Sudden increases in training load
• Training incorporating significant downhill running

How do you manage ITB syndrome?

Management of ITB syndrome should be multimodal. In the early stages, a decrease in training load and soft tissue techniques may decrease irritability of the condition. For long term management, strength training, graded running programming and gait retraining are important considerations. If indicated, some patients may have a corticosteroid injection to assist with pain, although this should not be a part of routine management.

How should I go about gym based rehabilitation for my ITB syndrome?

It’s difficult to say, as each individual will be quite different. I usually work through a process beginning with reducing irritability prior to commencing strength training. Strength training is usually directed Early stage strengthening exercises

How do you prevent it from occurring?

Many runners have risk factors for the development of ITB syndrome, however will not develop it until they have a training error. A training error usually includes a rapid increase in running load, such as large increases in distance, introduction of significant hill work and intensity of speed sessions. We also commonly see runners try to return from experiencing ITB syndrome too rapidly. The body requires time to recover and develop tolerance to training loads.

As such, the number one advice for runners is to be sensible with their running load. It helps to look at the previous 4-6 weeks of training as a gauge of how much running to plan for the following week. When adding or increasing hills or speed work, I often keep a runner’s overall weekly distance relatively similar to avoid injury.