Iliotibial band syndrome (ITBS)


CLITBSIliotibial band syndrome (ITBS) is among runners considered to be the most common pain problem caused by overloading the knee structures. There is a muscle group going from the inner side of the thigh from the pelvic bone, made out of gluteal muscles and iliotibial band. These muscles are transforming into a long iliotibial band, which is attached to the outer side of the knee. The muscles have a work to do, which is to stabilize the knee joint and at the same time secure its mobility during extension and flexion. If the function is disrupted and the muscles are incorrectly involved into the movement, pain occurs in the area of the knee which is caused by inflammation in the iliotibial band. The pain can be so serious, that it will make you stop with physical activities for several weeks.


The syndrome is usually manifested by a swelling, burning and pain on the outer side of the knee. For this reason many athletes incorrectly think that they injured their knee. The pain usually manifests on the outer side of the thigh, but sometimes it is transferred through the whole length of the thigh all the way to the gluteal muscles. The problems usually occur when the leg hits the ground, but it can also appear after the physical activity. One fairly reliable clinical test to prove or exclude the possibility of ITBS is to bend the knee in a 45° bend - if there is a pressure in the iliotibial tract or inflammation, you will feel pain on the inner side of the knee.

From imaging diagnostic methods, the ITBS can be sometimes proved by MRI (magnetic resonance), which will reveal a partial thickening of the band, that is a result of inflammation in the area of the iliotibial tract. Another option is examination of the diagnostic ultrasound, which also reveal the thickened band or soaking, which again points to the continual inflammation in the area of the iliotibial band.

The safest way is a quality clinical examination by a therapist, which can also reveal the ITBS syndrome.


CLBehaniITBS can be caused by almost any activity, during which you repeatedly bend your knee joint, often in combination with inward rotation of the knee. In the area where the iliotibial tract gets closer to the knee and directs down towards the attachment, the passage space for the band gets narrower and it leads to higher friction and repetitive burdening which can result in a in inflammation.

Pain are usually appearing after these activities:

  • Running in old/used shoes
  • Long lasting training, running up and down from stairs for example
  • Running down, running on tilted soles of the feet
  • Disproportionately long running route
  • Swimming breaststroke style

Water poloITBS is diagnosed usually more by women, probably because they have a higher tendency to keep the hip joints in the inner rotation, which keeps the knees in an inner position. Apart from other painful syndromes of the knee joint, ITBS affects experienced athletes nearly at the same rate as amateurs.


As a prevention against the syndrome or stopping the development of the problems in the starting phases we recommend to keep the following preventive measures:

  • Decrease the number of kilometers/miles you run normally, alternatively make your training a little less intensive for few days if the pain doesn't go away.
  • At first walk the first half kilometer with a swift walk before you start running. You will warm up your muscles and you will stop any further overload due to insufficient warm up.
  • Make sure that your shoes are not over worn from the outer side. If they are, change them.
  • Try to run in a terrain where both of your feet are in a same height position. Running in a “traverse” where one leg is higher than the other is one of the most common causes of formation of ITBS.
  • Avoid running on a concrete surface

CLPodoskop fill 224x150As soon as the pain occurs, the best treatment is to immediately stop and rest. That means to run less kilometers/miles, or avoid running for several days. In case of sudden overload without the formation of inflammation, the peaceful regime will be enough to prevent the occurrence of ITBS.

The pain in the knee area is a clear sign of dysfunction of the muscles - if this pain is ignored and you won't let your muscles rest, the ITBS can become a chronics problem (then it becomes harder to cure).


It is important during clinical examination to view the musculoskeletal system complexly and not to examine just painful knee joint alone. As it was mentioned above, iliotibial tract goes from the pelvic area and therefore it is necessary to examine the position of the pelvis, hip joints but also lumbar and thoracic spine. Just as important is the examination of the feet, position of the ankle joints, and activity of the muscles composing the foot arches. Most frequently the real cause of the problems is in the flat feet, inner rotation of the hip joints and poor quality activity of the back and abdominal muscles, which cause the incorrect position of the pelvis.
One of the main causes of unsuccessful treatments is incomplete approach, during which the therapist applies therapeutic ultrasound, electrotherapy just on the knee joint, but the real cause is left untreated. Even worse option is the usage of corticosteroids (hormonal drugs), which may decrease the inflammation for a shorter time, but it doesn't treat the cause, it only disrupts the structure of the iliotibial tract.

diagnosing pelvis

After a thorough clinical examination we step to physiotherapy, which leads to removal of the causes of the problems and its return. The base is to work on the correction of the posture of the musculoskeletal system during daily activities as well as during physical activity so that the joints and muscle structures wouldn't be overloaded. It is very important to apply soft techniques in the beginning of the therapy, because it releases the overloaded muscles and ligaments, which significantly lowers the pain. For the therapy we use most modern methods on a neurophysiological base (dynamic neuromuscular stabilization according to Kolář, sensory stimulation, Kabat method, exercising on BOSU, Flowin and many more).
The effects of quality physiotherapy are often visible already after first therapy. Knee joint is looser, without any burning or unpleasant pain. If you continue to exercise and correct your running technique, the pain will occur significantly less frequently until it fades away completely.

Video example of physiotherapeutic methods and techniques:

Stretching the ITB PNF for legs


Part of the modern physiotherapy, which leads towards the fastest removal of your problems, is focused shock wave therapy in combination with radial shock wave therapy and application of kinesio tape. The shockwave helps to remove the inflammation, start the repairing mechanisms of the body and relax the overloaded muscles. The result is often visible after first application, when the pain is significantly lower as well as the swelling in the area of the knee joint.
If the shockwave therapy is performed in combination with physiotherapy the effect of the treatment is very fast and temporary. Therapy is supplemented with application of functional kinesio tape, which supports the muscle activity and it helps to optimize the function after the patient leaves the therapy. At the same time it helps the muscles to be correctly involved in activity when you return to running, which also helps to get back as fast as possible to the original physical shape.

Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from private practice in physiotherapeutic field, FYZIOklinika

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