Illiotibial Band Friction Syndrome

What is it?

Iliotibial band friction syndrome (ITBFS) is one of the leading causes of knee pain in athletes. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis over the hip and knee and inserting just below the outside of the knee. This band is crucial in stabilising the knee during running.

The continual rubbing of the band over the bone, combined with the repeated bending and straightening of the knee during running causes the areas described above to become inflamed and the band itself mat become irritated.

ITBFS is most common in athletes who participate in long distance running and has also been reported in cyclists and tennis players. An increased frequency of ITBFS occurs during the rapid growth phase of adolescents.

Mechanism of Injury

ITBFS is the result of poor training habits and anatomical abnormalities. For example, running downhill causes the leg to bend slightly inward and therefore causes extreme stretching of the band against the thigh bone. Other causes of ITBFS include running excessive distances or increasing distances too quickly can aggravate the ITB and inadquate warm up and cool down.

Signs and Symptoms:

  • Stinging sensation just above the knee joint on the outside of the knee or along the entire length of the iliotibial band

  • Pain may not occur immediately, but will worsen during activity when the foot strikes the ground if you run downhill persisting afterwards

  • Sometimes is associated with a ‘snapping hip’ in which the muscles that cross the outside of the hip can be felt to snap or click during walking and running

There may be swelling and a thickening of the band at the point where the bands moves over the thigh bone.

Common Management Techniques

Once a diagnosis is made, management of ITBFS includes:

  • Reducing or stopping the activity that provokes pain and only resume it when the pain has disappeared

Physiotherapy will aim to:

  • Address faulty pelvis mechanics

  • Teach appropriate stretching techniques of the hip muscles

  • Use massage over the outside of the thigh to release any tight muscles

  • Address any faulty foot mechanics and the need for a good pair of running shoes to support the foot and/or orthotics.

  • Return to running gradually. Build up slowly to pre injury level and add in hills gradually


Most patients will recover completely if they follow the recommended treatment plan for iliotibial band friction syndrome. You can help prevent this condition by stretching before any physical activity and performing regular exercises to strengthen the muscles in the legs.