The itiotibial band is a band of strong connective tissue which runs from the pelvic bone down the outside of the thigh to the top of the shin bone. Iliotibial band friction syndrome is a condition which describes the rubbing of this band of tissue as it passes over a bony bump on the outside of the knee joint.

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ITBFS is an overuse injury common in runners and cyclers. When the knee is bent and straightened, the iliotibial band slides over a bony bump on the outside of the knee. When this is performed repeatedly or when the band is excessively tight, wear and tear of the band can develop as it flicks over the bony bump. To heal this damage, the body commences an inflammatory response. ITBFS can result from one or more of the following faulty training habits, anatomical abnormalities or muscular imbalances:

Training habits:

⦁ Frequently running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur

⦁ Inadequate warm-up or cool-down

⦁ Excessive up-hill and down-hill running

⦁ In cycling, having the feet “toed-in” too much

⦁ Running up and down stairs

⦁ Hiking long distances

⦁ Rowing

Abnormalities in leg / feet anatomy:

⦁ High or low foot arches

⦁ Supination (running on the outside of the foot)

⦁ Excessive lower leg rotation due to over-pronation

⦁ 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)

Muscle imbalance:

⦁ Weak hip abductor muscles (lifting the leg out sideways)

⦁ Weak / non-firing multifidus muscle (stabilising muscle in the back)


ITBFS results in pain felt on the outside of the upper leg or knee. Pain range from a stinging sensation just above the knee joint (on the outside of the knee or all along the outside of the thigh) to swelling or thickening of the tissue at the point where the band moves over the bump on the outside of the knee. The pain is often aggravated by activities which involve repeated bending and straightening of the knee such as running especially with foot strike. It typically develops gradually. Initially, the pain may begin as a dull ache down the side of the knee which appears near the end of the session and disappears when you stop. However, if you continue to exercise and cause further rubbing of the iliotibial band, the pain may progress to become more intense which may also take longer to disappear when you stop exercising.


Physiotherapy will include Ultrasound, Cold Laser Therapy, Interferential Therapy, eccentric loading and strengthening exercises, dry needling and stretches. Causes identified above, should be corrected including faulty training techniques, biomechanical problems and muscle imbalances. These corrections might also include inner soles for your shoes, taping of the knee, bracing and posture correction