Written by Isabella Rigby

Is your knee sore after a big run or game of football? Haven’t had a problem in the past? Not really sure what caused it? It may be Iliotibial Band Friction Syndrome (ITBFS)….

Here at Forster Tuncurry Sports Podiatry we assess and treat a number of lower limb conditions associated with running, and ITBFS is one of the most common affecting the knee.

ITBFS is the second most common cause of knee pain in runners (1)

The iliotibial band (ITB) is made up of thick connective tissue which originates from the anterior and lateral muscles of the hip, and inserts just below the knee on the outside of the tibia bone (see green strip in photo). It provides stabilisation of the hip and knee, and limits excessive internal knee movement.

Symptoms of ITBS
– Aching pain above the knee cap and on the outside of the knee.
– Pain during and after repetitive impact activity
– Swelling may be present on the outside of the knee
– Pain is produced when knee is initially bending during walking or running

What causes it?

  • Friction of the ITB: the ITB slides across the outside bony bump of the knee where it inserts onto the outside of the tibia. This repetitive motion can cause excess friction at this point, especially when the knee is bent at 30 degrees (seen when your heel strikes the ground during activity).
  • Weak surrounding muscles: relative weakness of the TFL, Gluteus Medius, Gluteus Minimus and other external rotator musculature of the hip leads to excessive internal motion of the during running, which can increase the ITB friction. Weakness of these muscles often results in chronic “fatigue” and “tightness” of these muscles over time.
  • Biomechanical abnormalities: increased internal rotation of the femur bone, knock kneed position and excessive / high velocity pronation of the feet (rolling in / flat footed) can all contribute.
  • Excessive overload

Many people have heard the phrase “too much too soon” and this is a major contributor to ITBFS.

Research has shown that if you load tissues everyday that overall there can be a net breakdown in collagen…if continued excessively it weakens and the structure changes (4).

If you train every day without rest or just started training without a gradual increase in intensity, you run the risk of many lower limb injuries, including ITBFS.

  • Female Gender:

Sorry girls, but women are twice as likely to develop ITB syndrome as men due to greater angulation of their hips relative to their knees (2)


Comprehensive Biomechanical Assessment
Our 1 hour biomechanical assessment analyses movement patterns, force distribution, skeletal alignment, strength, balance and posture. We utilise a range of non-weight bearing and weight bearing joint/muscle assessments, and both digital and visual gait analysis to help us make an accurate diagnosis. We then construct a treatment and rehabilitation plan specific for you and your exercise goals

Custom Foot Orthotics
Should your biomechanics be contributing to your ITBFS, you may possibly require custom foot orthotics. Orthotics are inserts specifically moulded for your feet that you place in your shoes, to redistribute and optimise forces acting on and within the body that may be placing excess stress on your tissues.

Footwear advice
Your shoes play an important role in supporting the foot and helping to prevent lower limb injuries. Many shoes out in the market have no midsole support!! This is why seeing a podiatrist is necessary as we educate and show what aspects of a shoe are important for your specific needs.

Strengthening + Stretching Program
A strengthening and stretching program for core, hip and lateral thigh musculature will be critical for prevention / rehabilitation of ITBFS.
In particular, the gluteus medius muscle’s role is to rotate the knee away from the midline of the body, and support straightening of the knee through the ITB. If the gluteus medius is weak, the load is now placed on other muscles to compensate. The ITB as a result also overcompensates, causing excessive tension at the level of the knee, leading to ITBFS.

Gluteus Maximus extends the hip and has a major role in supporting the leg during midstance phase. It attaches to the ITB and its function is to also externally rotate the hip. Any weakness in glut max is going to also affect the stability in the pelvis and cause extra tension through the ITB.

Building strength in the quads controls knee position when the foot strikes the ground and knee bends. Weak quads contribute to poor control of knee placement therefore creating extra load on the ITB.

A Podiatrist will perform a biomechanical assessment to determine the best treatment program suits you, as every individuals muscle tightness and weakness is different all the way down the kinetic chain.

Manual Therapies
Dry needling, massage and shockwave therapies are used for the treatment/management of many acute and chronic lower extremity injuries in the initial stages of rehab, and achieve good results in restoring tissue back to an optimal state. They are not however a long term solution, and will taper off as we progress through the exercise program and load management.

Dry needling in particular involves the insertion of a fine filament needle into the muscle belly to assist with decreasing pain as well as improving function through releasing myofascial trigger points (knots in the muscle). Myofascial trigger points (TrPs) are a group of muscle fibres, which have shortened when activated but haven’t been able to lengthen back to a relaxed state after use. A sensitive nodule is formed due to the fibres becoming so tight they compress the capillaries and nerves that supply them. Therefore the muscle is unable to receive nutrients and oxygen from fresh blood causing the muscle to not activate to its potential. Injury, change in regular activity load, sustained postures (prolonged sitting for work or study) are causes for the development of TrPs.

ITBFS is an extremely common overuse injury of the lateral knee/thigh, and may be the cause of your knee pain. There are a number of factors contributing to it, and many more ways that we can help! Be sure to contact us on (02) 6557 2034 to book an appointment today!


(1) Van der Worp, M.P., Van der Horst, N., De Wijer, A. et al. Sports Med (2012) 42: 969. https://doi.org/10.1007/BF03262306

(2) Phinyomark, A. et al. (2015) ‘Gender differences in gait kinematics in runners with iliotibial band syndrome’, Scandinavian Jounrla of Medicine and Science in Sports, 25(6), pp. 744-753. http://search.ebscohost.com/login/aspx?direct=true&db=s3h&AN=111115471&site=eds-live (Accessed 10 March 2019)

(3) LUGINICK, B. S. et al. (2018) ‘Kinematics of recreational runners with iliotibial band injury’ Journal of Human Sport & Exercise, 13(3), pp. 698–709. Available at:  http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=131844286&site=eds-live (Accessed: 10 March 2019)

(4) Tom Goom, March 2012, Running Injuries-ITBS, Running Physio, March 2019, https://www.running-physio.com/itbs/

(5) Shahab Shahid, Urui Zehra, Catarina Chaves, 2019, Iliotibial Band, Kenhub GmbH, March 2019, https://www.kenhub.com/en/library/anatomy/iliotibial-band

(6) Author Unknown, 2019, An Introduction to the ITB and its Syndrome, Recover Sports Medicine, March 2019, http://www.recoversportsmed.com.au/itbs-syndrome.html

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