Sports and Spinal Physio LTD
24 Tallon Road
CM13 1TE

ITB Friction Syndrome

ITB Friction Syndrome

Where is it?

The iliotibial band is a strip of non-elastic tissue. It originates at the side of the pelvis where it blends with the hip muscles (Gluteus Maximus and Tensor Fascia Latae) from here it descends down the outside of the thigh, attaching to the thigh bone but more importantly to the end of the thigh bone on the outside (lateral femoral condyle), the knee cap (patella) and the top of the bottom leg bone (tibia).

What causes it?

Injury to the ITB is common in distance runners. As the knee is bent and straightened during running the ITB moves over the outside of the knee. It is believed that in some runners compression of the fatty tissue between the ITB and knee occurs and as such becomes irritated, inflamed and painful. Pain onset may occur early or late in the run or even after and is normally located to the outside of the knee. It is often described as a sharp or burning pain and is worse running down hill as the knee flexes.

There are many factors that contribute to the cause. From our own observations in the clinic we feel the most significant finding is a positive Trendeleberg sign. This is where the pelvis drops down on the non-weight bearing side during running and best observed from the back on slow motion video footage. This problem is predominantly the result of weak hip abductors mainly gluteus medius but also due to a lack of core stability. As a result of slow activation and or weakness / lengthening of the gluteals the pelvis on the weight bearing leg is uncontrolled causing it to drop down on the non-weight bearing side. This in turn will pull the ITB tight against the knee and compress the tissues as described above.

Other causes

  • Incorrect foot biomechanics e.g. over-pronation (flat feet).
  • Training errors – increasing training distance or intensity too fast.
  • Poor footwear.
  • Incorrect lower limb biomechanics (bowed knees), leg length differences or running style.
  • Over striding, running on cambered roads and poor footwear.

What can be done?

Initially rest is normally advised so as not to cause any prolonged or further injury/pain and anti-inflammatory drugs and pain killers may be prescribed by your GP to help settle things down. Application of ice is also useful in alleviating pain and decreasing the inflammatory reaction within the tissue.

However to resolve the problem a biomechanical assessment is required to identify faults within the muscle system around the pelvis – predominantly the gluteals and abdominals. A formal assessment of foot structure and function during gait is also essential.

Treatment includes:

  • Tailored home exercise programme to address weakness and muscle activation.
  • Lengthening of shortened muscles.
  • Footwear modifications and addition of orthoses (shoe inserts).
  • Correction of running style.
  • Improved running technique.
  • More attention to distance and intensity.
  • Ultra-sound and application of ICE.
  • Foam rolling/ soft tissue massage and manipulation.
  • Lastly – steroid injection and surgical removal of irritated tissue – urgh!!

For more information on ITB friction Syndrome there is a great article which goes into far more depth at

For examples of video footage of a Trendeleberg syndrome please see our youtube channel.

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