• Danielle Labuschagne

ITB the other runner’s knee…

What is your ITB and why is it becoming grumpy?


The ITB (iliotibial band) is a long tendinous continuation of one of the muscles in your hip area, called the Tensor Fascia lata, and a part of your gluteal (bum) muscles. The ITB runs from the top part of your femur down your leg and attaches into your patella (kneecap) and the top part of the tibia.


ITB syndrome is the most common cause of lateral knee pain in runners. It is believed to result from the repetitive friction that occurs as the ITB slides over the lateral femoral epicondyle that forms the knee joint. This continuous friction causes irritation and a subsequent inflammatory reaction and thus leads to lateral knee pain.


When your knee is straight, the ITB is anterior to the epicondyle and as you bend your knee it moves to posterior of the epicondyle. It was also found that there is an impingement zone of the ITB between 20° and 30° knee flexion.


Risk Factors and Causes:


  • Running on cambered roads with the same foot striking in the cambered part of the road continuously.

  • Greater- than- normal weekly mileage

  • Excessive running in the same direction on a track

  • Downhill running

  • Weakness of the hip abductors causing the hip to drop – increased hip adduction Increased internal rotation of the knee (“knock knees”)

  • Flat feet

  • Running shoes that are too worn or too new

  • Leg length discrepancy

  • Longer stride length

  • Sitting with the knee in a flexed position for long periods may aggravate the pain



Weakness of hip abductors:

Your hip abductors consist of the gluteus medius muscle and to a lesser extent the Tensor Fascia lata. Runners with ITB syndrome were evaluated against a control group. It was found that the runners with ITBS had a significant weakness in hip abductor strength of the affected limb compared to the uninjured limb and the control group.


Signs and Symptoms:


ITB syndrome is mainly described as pain on the outside (lateral side) of the knee.


  • The pain is described as a sharp or burning pain

  • Local tenderness and occasional swelling or thickening of the tissue of the iliotibial band close to the knee joint may occur (2-3cm above the joint line)

  • Pain or abnormal sensation may occur along the length of the band

  • Some may report a clicking or snapping sensation

  • The symptoms typically come on after a reproducible time or distance of running

  • Early on the symptoms will subside shortly after a run is over and then return with the next run. However, if the condition is allowed to progress the pain will not subside after a run and lateral knee pain might be felt with daily walking or stair climbing.

How do I turn the ITB frown upside down?


1. The first goal is to decrease the inflammation at the site where the ITB undergoes repetitive friction. (2 – 3 cm above the knee joint)

  • Massage the area with ice

  • Oral anti – inflammatory medication to reduce unnecessary inflammation and accompanying pain

  • Avoiding downhill running or running in the same direction might help.

  • Avoiding all other activities adding to the friction of the ITB, such as cycling.

  • In extreme cases a local corticosteroid injection may be helpful

However, this will not effectively heal the injury. The runner has to modify and change the causative factors.


2. Once the acute inflammation is under control, the runner can start with stretching of the ITB. This helps to lengthen the ITB and reduce the tension on the ITB, resulting in decreased friction.


3. Rehabilitation :

  • Depending on the causative factors of ITB syndrome, different rehabilitation methods could be used.

4. Physiotherapy:


A thorough examination of the patient’s biomechanics, posture and pattern of running is needed to determine what causes the excessive tension and friction on the ITB.


  • Pain treatment: massage, cross frictions, ultrasound, laser etc.

  • Posture – look for flat feet, fallen foot arches, increased rotation of the knees or hips. This should be adjusted with strengthening or stretching.

  • Strengthening weak gluteus medius and hip abductor muscles

  • Stretching shortened or tight quads, hamstrings and ITB

  • Loosening tight quads, hamstrings and TFL with deep massage

  • Dry needling trigger points in the quads, hamstrings and TFL

  • Foam rolling to loosen tight muscles

  • Strengthening the adductor muscles to reduce the strain on the lateral thigh muscles

  • Quads and hamstring control exercise to increase knee control

  • Knee joint mobilisations

  • Balance and proprioception exercises

  • Strapping


Get that ITB pain free and the fun back in you run …

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Danielle Labuschagne Physiotherapy; Paarl Physiotherapy

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