ITB friction Syndrome

With marathon and triathlon season started we are seeing more and more running related injuries at JUMP Sports Injury Clinic. By far the most common type of running injury/ sports injury we see is an over load injury to the Ilio Tibial Band (ITB) called ITB friction syndrome. Here is a brief discription of the injury and some common causes.

The Ilio Tibial Band  (ITB ) is a thickened band of connective tissue  that runs down the outside of the thigh. As the knee flexes and extends the ITB glides over the lateral femoral condyle, a bony prominence.

If the load across the ITB is increased the point where the ITB runs over the femoral condyle can become inflammed leading to pain and to what is commonly called ITB friction syndrome.

ITB Syndrome commonly presents with the following symptoms.

  • A dull ache on the outside of the knee that increases during a run gradually getting worse for the duration of the run., Pain is often worse the next morning. It can be aggravated further by running downhill, on cambered surfaces or walking downstairs.

ITB friction syndrome is an over use injury with several proposed potential contributory factors.

  • Run technique: Stride length has been proposed to affect both the size of knee bend and thus the load across the ITB. Excessive stride length seems to aggravate the ITB where as pain is often reduced when the length of the stride is reduced.
  • A tight ITB as measured by the Ober’s Test is thought to be a contributory factor to ITB friction syndrome.
  • Training Error: As with all over load injuries doing too much of a particular type of training places excessive loads across the joints. Even if cardiovascularly you feel fine you need to gradually build up your training. What is too many miles unfortunately depends on the individual. In clinic the most common training error we see are runners running the same route 3 times a week at the same pace and gradually increasing the times spent running. If you run the same route night after night at the same pace you are loading your joints muscles in the same way on the same surface night after night. Try varying the length of your runs, the speed of your session and the terrain you run on. 
  • Anything that causes the knee to track medially (towards the mid line of your body loads the ITB. This increases the load over the femoral condyle. Various bio mechanical reasons can cause your knee to drop medially
  1. Weak Hip Abductors. The muscles on the side of your pelvis namely the gluteus medius muscles help control your pelvis when you run.  When you lift your left leg off the ground your right gluteus medius muscle contracts and stabilises the pelvis keeping it level. When your gluteus medius muscles are weak the left side of you pelvis drops and the right knee is pulled across the midline as run. This is repeated endlessly as you run.

Reference :

  1. Over pronation of the feet. Feet that over pronate on impact cause the knee to follow the foot and drop medially. By far the most common and correctable cause of over pronation in runners are tight calves.



  • Have yourself assessed by a chartered Physiotherapist who can diagnose the problem, identify your unique contributory factors and get you back on the road to recovery.
  • Rest from running until the inflammation decreases.
  • Avoid downhill running and running on cambered surfaces.
  • Speak to your pharmacist. Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs.
  • Apply ice to the knee (for 20minutes every evening ) in order to reduce the inflammation
  • Self-massage/ stretching on a foam roller
  • Remember to stretch well before running
  • Address any training errors


Recovery: Time to full recovery depends on the extent and cause of the injury. But a general rule is the earlier you address the problem the quicker you’ll recover.

Preventative measures:

  • Regular stretching of the ITB, quadriceps, hamstring, and gluteal muscles.
  • Gradual progression of training program
  • Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road)
  • Working on run efficiency and stride efficiency.
  • Build some regular core strengthening exercises such as Pilates into your routine.
  • Regular sports massage