Iliotibial Band Friction Syndrome

Tell any long-distance runner or cyclist about your stinging pain at the side of the knee or hip, and you will get a knowing sympathetic look. ITB (Iliotibial band) friction syndrome is one of the commonest complaints amongst runners, cyclists and intense court sports.


ITB friction syndrome gets its name from the Iliotibial Band rubbing against a bony protrusion just at the side your knee. The ITB is a continuation of one the largest hip muscles and spans as a thick band of tissue on the outside of the thigh. Starting from the pelvis, it runs over side of the hip and ending just below the knee. Just before it crosses the knee, it runs over a protrusion in the thigh bone (lateral femoral epicondyle). The frequent rubbing of the band over this bony protrusion from bending and straightening of the knee irritates the band, causing an inflammation. The tighter the ITB, the harder it rubs over the protrusion.

What tightens the ITB?

Three basic things tighten the ITB.

  • Training methods
  • Bio-mechanical gait issues
  • Weak outer thigh muscles

Training Methods

Running on banked surfaces, inadequate warm up or cool down, increases in distance too fast or excessive downhill running are faults associated with running which strains the ITB. In cycling having the feet toed inwards commonly causes the band to get tight.

Bio-mechanical Gait

Problems with foot structures such as high or low arches and uneven leg length typically tighten the ITB on one side. A complete biomechanical assessment helps determine the faults. Where appropriate, foot orthotics can correct these problems.

Weak outer hip muscles

Weak outer hip muscles forces the ITB to work harder to compensate and becomes tight as a result. Exercise to strengthen the outer hip muscles helps to lighten the load on the ITB. Despite avoiding all the three issues mentioned, athletes with a high training volume often still experience painful ITBs. In such cases, deep tissue massage will help release the tight band.

Don’t forget to stretch the ITB. Ignoring ITB tightness can lead to groin pain and low back pains.

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