ITB Syndrome

August 20, 2018 | By | Reply

– Dr. Sneha Parekh

If you are getting pain on outer aspect of knee, specially during a run, you might be having a condition called the ITB syndrome.

What is ITB syndrome?

The iliotibial band (ITB) is a fibrous band surrounding the muscles on the outer part of thigh and runs from the hip to the shin. The ITB attaches to a muscle called the tensor facia lata (TFL). It is one of the most common overuse injuries among runners and occurs when the TFL is tight or the ITB facia becomes inflamed.

art_itb-ilio-tibial-band-syndrome-01 art_itb-ilio-tibial-band-syndrome-02

The ITB attaches to the knee and helps stabilize the joint. If your buttock muscles are weak, your knee might roll inward when the foot strikes the ground during running. The knee might also roll inwards if you have flat feet or your foot rolls inwards. This may cause constant rubbing between the bone and the band due to repetitive movement while running. This irritation and inflammation causes pain.

Apart from runners, ITB syndrome is common in cyclists, military personnel and other athletes.


  • Poor biomechanics specially of hip and knee rolling inwards or faulty foot alignment
  • Running downhill, wearing worn out shoes or running on uneven surfaces
  • Muscle imbalances
  • Sudden increase in frequency or distance of running
  • Too many surface changes while running
  • Improper training habits


  • Sharp pain on outer aspect of the knee specially while running which can radiate to outer thigh or down to the calf
  • Pain may be generally present when the foot strikes the ground and may persist post activity
  • Pain on repeated knee movements of bending and straightening the knee


  • Tenderness may be felt on the outer aspect of the knee
  • Triggers are generally felt on the TFL or Vastus lateralis (outer muscles of the thigh)
  • Tight TFL muscle
  • Weak glutes and core muscles


Diagnosis of ITB syndrome generally does not require any imaging. Ultrasonography or MRI can be done which will show thickening of ITB where it attaches to the knee and often a fluid collection at the same site.


  • Activity modification: To avoid and modify all pain provoking activities such as downhill running.
  • Pain relief: Cold packs, anti-inflammatory medicines or electrotherapy modalities like ultrasound can be used.
  • Soft tissue therapy: It is aimed at correcting excessive tightness in the TFL and vastus lateralis. Techniques such as myofacial release, dry needling, frequent stretches of the tight structures, self massage by foam roller can be done.
    Myofacial release

    Myofacial release

    Stretching for TFL

    Stretching for TFL

  • Taping: Kinesio tapes can be used to offload the tight structures.
  • Strengthening: Strengthening of the weak muscles such as the glutes and the core muscles should be done to correct the muscle imbalances and to prevent excessive strain or overworking of the vastus lateralis and TFL muscle which attach to the ITB.
    art_itb-ilio-tibial-band-syndrome-05 art_itb-ilio-tibial-band-syndrome-06
  • Correction of the foot posture if present should be done.


The prognosis for ITB syndrome is very good if the athlete maintains good flexibility and corrects the factors leading to it.

We at PHYSIOREHAB do detailed evaluation of your complaints and help by charting an individualized programme to get you rid of your pain and get you back to running.

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