Iliotibial Band Syndrome – The commonest cause of knee pain in runners

Tuesday, 03 November 2015 1041 Views 0 Comments
Iliotibial Band Syndrome – The commonest cause of knee pain in runners

By Shailja Kaushik

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners, with incidences as high as 12% of all running-related overuse injuries.[i]

What is iliotibial band syndrome?

The iliotibial band is a thick group of fibrous tissues on the side of the knee that runs from the pelvis to below the knee. This band of tissues runs from the back to the front of the femur, and helps to stabilise the knee and hip during movement.  Each time an individual makes a movement involving knees or hips, this band of tissues rubs against the bone and this friction results in iliotibial band syndrome (ITBS). ITBS is defined as intense pain on the outside of thighs and knees due to the overuse of these tissues in the area. Tennis players, cyclists, runners and those participating in aerobic activities are commonly affected by this syndrome, but sprinters rarely develop this injury.


  • Excessive use of the tissues in athletes such as long-distance or marathon runners
  • Inflexible or weak muscles of lower back, thighs, pelvis, hips and knees
  • Discrepancy in the length of the legs
  • Bow legs
  • Abnormal orientation of the pelvis
  • Very tight or wide iliotibial band
  • Flat feet or overpronation
  • Running downhill

According to a research study, several training factors have been associated with ITBS including excessive running in the same direction on a track, greater-than-normal weekly mileage, and downhill running, where decreased knee flexion at foot strike increases friction between the ITB and the lateral epicondyle.[ii]

In general, activities or sports such as rowing, weight lifting and cycling, which involve a lot of squatting and flexion of knees, are known to cause symptoms of iliotibial band syndrome. Cyclists are also at higher risk of developing ITBS because they have improper posture on the bike and cleat while pedaling.


ITBS is one of the most common causes of lateral knee pain in runners. It is characterised by:

  • A sore spot when you flex the knee past 35 degrees [iii]
  • Pain on the outer part of the knee or hip. Pain usually occurs while the person is running, thus forcing him/her to stop the activity. After the activity is stopped and the person takes some rest, the pain goes away but comes back when the activity is resumed. Running aggravates the pain. Straightening or bending the knee also results in pain and tenderness. In the initial stages, there may be a pricking or stinging sensations that transforms into disabling pain at later stages
  • A lateral or external snapping hip. Athletes, and dancers, sometimes cite an audible painful snap on landing in poor turnout, and with excessive anterior pelvic tilt.[iv]


  • Here are five ways by which you can prevent iliotibial band syndrome:
  • Whenever you feel pain on the outer part of the knee, reduce the pace and distance of your run
  • Warm-up by walking some distance before running
  • Replace your worn-out shoes
  • Don’t run on the same side of the road. It is best to either change the side on alternative days, or run in the middle of the road
  • Avoid running on hard surfaces
  • Use orthotics after checking with your podiatrist
  • Never increase your running mileage by more than 10% per week.


In the book Iliotibial Band Syndrome (Published by Sports Medicine, 1992), authors summarise treatment modalities for ITBS as rest or decreased distance, shoe changes, modification in exercise techniques, anti-inflammatory medication, steroid injections and stretching. Surgery is not required.[v]

RICE – rest, ice, compression and elevation, is the first line of treatment for correcting iliotibial band syndrome. Pain, swelling and inflammation can be treated with anti-inflammatory medicines. If the pain persists, physical therapy involving flexibility and stretching is required. Sports massage by a professional therapist will help to overcome the tightness of the band. Shoe orthotics may be useful in correcting those cases where biomechanical issues are responsible for the condition. Reduction in the intensity and duration of training or alternative training regimen will also prove to be helpful. Incorporation of flexibility and strengthening exercises into the treatment is often recommended.[vi]

Phonopheresis (use of ultrasound) or iontophoresis (use of electricity) are the other therapeutic techniques used for treatment. Only when the conservative methods of treatment fail to produce satisfactory results, surgery is advised for the patients.

[i] Taunton, J.E., Ryan, M.B., Clement, D.B., McKenzie, D.C., LloydSmith, D.R., Zumbo, B.D., 2002. A retrospective case–control analysis of 2002 running injuries. British Journal of Sports Medicine.
[ii] Steven I. Subotnick. Sports & Exercise Injuries: Conventional, Homeopathic and Alternative Treatments. North Atlantic Books, 1991.

[iii] Linderburg G, Pinshaw R, Noakes TD. Iliotibial band syndrome in runners. Phys Sportsmed 1984
[iv] Walter Frontera, Julie Silver and Thomas Rizzo. Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences, 2014.
[v]  F. Alan Barber and Allan N. Sutker. Iliotibial Band Syndrome. Sports Medicine, 1992.
[vi] Baker RL, Souza RB and Fredericson M. Iliotibial Band Syndrome: Soft tissue and biomechanical factors in evaluation and treatment. PMR, 2011.

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on or +91 982017 13941)

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