ITB Friction Syndrome

SallyP 224x300 ITB Friction Syndrome The Fun Run season is well and truly upon us and nowadays there seems to be an explosion of amateur runners participating in anything from 2km to marathons and beyond.   ITBFS (Iliotibial Band Friction Syndrome) is one of those debilitating injuries that can stop a runner in their tracks and is not just limited to runners.  Cyclists, hikers and military personnel are also at risk.

So what is your ITB and how do things go wrong?

Your ITB is a long, flat, fibrous band running from the top of your pelvis down the outside of your leg to insert down on your tibia and femoral condyle (the bony end of your thigh bone).  As your knee bends and straightens, during running, cycling etc, the bottom end of the ITB slides across the outer condyle of your femur and can cause excessive friction and therefore inflammation and pain.  The most likely point where friction can occur is when the knee is bent to 30 degrees (think downhill running).

Common risk factors for developing ITBFS are:

  • Poor lower limb biomechanics and balance
  • Weak gluteal muscles
  • Weak inner quadriceps
  • Weak trunk core muscles
  • Poor foot biomechanics
  • Worn out or unsuitable runners
  • Sudden increase in mileage for training
  • Excessive hill training (particularly downhill)
  • Training for endurance events (half marathon and beyond)
  • Training/competing on unstable ground (eg bush tracks)
  • Stiff ankle joints (perhaps related to a past injury)

What are the symptoms?

People commonly describe a sharp pain or burning sensation on the outer side of their knee and or thigh.  Onset is usually gradual over a period of a few weeks and the pain worsens with running, walking or running downhill, stairs and knee bending.

Diagnosis of ITBFS

Diagnosis is relatively straight-forward in the clinic and does not usually require radiological investigation.  Your physiotherapist would look at your balance, muscle strength, lower limb control, joint range and core stability as well as discussing footwear and training programs.  Where possible it is beneficial to perform a running or cycling video analysis to visualise your lower limb biomechanics in action.


Treatment can be very effective once all contributing factors have been identified.  Physiotherapy management commonly consists of hip and gluteal strengthening, ankle joint mobilisation, soft tissue techniques, agility and balance exercises, activity and training modification and sport specific drills with a view to returning to the starting line.  Occasionally a corticosteroid injection is required (performed by a sports’ physician) but in most cases conservative management will get you there.

From Sally at Focus Physiotherapy

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