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Iliotibial Band Syndrome

31st May, 2012

ITBIliotibial band (ITB) syndrome generally presents as a pain on the outside aspect of the knee that gradually increases over a few days to weeks. It can be a result of wearing worn-out shoes, running downhill or on banked surfaces, running on tracks in the same direction, or simply running too many miles. Pain generally occurs on extension of the leg just before the heel strike phase of running/walking, and a squeaking can sometimes be heard on extension and flexion of the knee.

ITB pain affects seasoned runners almost as much as beginners. Evidence suggests that downhill running, or slow jogging are major causes of this syndrome and that running at faster speeds is a less likely cause as the knee is not held between 30-40º of knee flexion for prolonged periods. Rubbing of the ITB on the lateral epicondyle of the femur occurs between the 30-40 º of knee flexion.

The main functions of the ITB are to assist the hip muscles in abduction (outward movement) of the thigh and to stabilize the outside aspect of the knee. The ITB is not a strong structure, and if the surrounding muscles have any weakness this can predispose a person to injury and ITB syndrome. Runners are notoriously weak in their hip and core muscles, particularly if strength training or exercises involving side-to-side movements are not part of their normal training regime.

In a study published in the Clinical Journal of Sports Medicine (July 2000), Dr. Michael Fredericson, a physical medicine MD at Stanford University, compared 24 runners with ITB syndrome with 30 healthy runners and found the injured runners to have a statistically significant weakness of the hip abductors (mainly gluteus medius and minimus) compared to the non-injured runners.  In a retrospective study by Ferber et al (2010), it was found that correction of atypical lower extremity kinematics should decrease iliotibial band stress/strain and should be considered in the treatment of persons with ITB syndrome.

Modification of aggravating activities is essential in the initial stages of injury and a thorough assessment of the low back and affected leg as well as analysis of walking/jogging patterns is recommended. Manual therapy such as Chiropractic, Osteopathy or Physiotherapy is ideal in order to speed return to normal activity.

Initially, rest may have to play a part in the recovery from this syndrome. Manual therapy treatments, ice, and stretching three times a day will also play a part in the early stages of recovery. Cross training that does not aggravate the condition can be done to maintain fitness. Deep tissue massage and mobilisation of the tissues is also beneficial in the initial stages of recovery and should also be done during the latter stages, which must include strength training of the hip and thigh muscles. Fadil suggests frequent massage to aid the recovery of this syndrome with elite athletes requiring this once a day and recreational runners requiring it 2 or 3 times a week. A foam roller can work very well for self massage.  In severe cases, a corticosteroid injection may be required.

Contributing Authors:
Shelley Doole DC MChiro


Ferber, R., Noehren, B., Hamill, J., Davis, I. Competitive Female Runners With a History of Iliotibial Band Syndrome Demonstrate Atypical Hip and Knee Kinematics. Journal of Orthopaedic & Sports Physical Therapy, 2010; 40:2 

Fredericson, M., Cookingham, C.L., Chaudhari, A.M., Dowdell, B.C., Oestreicher, N., Sahrmann, S.A. Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome. Clinical Journal of Sport Medicine: 2000; 10:3:169-175.

Fredericson, M., Wolf, C. Iliotibial Band Syndrome in Runners: Innovations in Treatment. Sports Medicine, 2005; 35:5:451-459(9)

MacMahon, J. M., Chaudhari, A. M., Fadil, A. M., & Andriacchi, T. P. (2000). Iliotibial Band Syndrome injured runners increase flexibility using soft tissue mobilization and increase functional strength using a heat pack-implications for faster recovery. 18th International Symposium on Biomechanics in Sports.

 Wang TG, Jan MH, Lin KH, Wang HK. Assessment of stretching of the iliotibial tract with Ober and modified Ober tests: an ultrasonographic study. Arch Phys Med Rehabil. 2006;87(10):1407-1411.

Wang HK, Ting-Fang Shih T, Lin KH, Wang TG. Realtime morphologic changes of the iliotibial band during therapeutic stretching; an ultrasonographic study. Man Ther. Aug 2007.