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  • Dori Nissenson

Running into Fall

Iliotibial Band (ITB) Syndrome.

Are you a runner that suffers from intermittent knee pain? Have you been told that you have a tight iliotibial band or ITB? If you have knee pain that is on the outside of your knee when you run, you may have ITB syndrome….

Now, you may ask what is ITB syndrome?

ITB syndrome is an overuse injury of the iliotibial band which is the connective tissue that is located on the outer thigh and knee. The iliotibial band runs along the outside of the thigh from the pelvis to the tibia, crossing both the hip and knee joints. The ITB stabilizes the outside aspect of the knee joint as it flexes and extends during movement.

It is believed that ITB syndrome is caused by the continual rubbing of the band over the lower part of the femur or the thigh bone during the repeated flexion and extension of the knee with running. This will cause inflammation and pain at the outside of the knee joint.


the inflammation can cause scarring in the knee joint and decreased knee joint range of motion which can seriously affect one’s ability to run.

How Do You Know If You Have ITB Syndrome???

Running downhill or walking down stairs can trigger the development of ITB syndrome. As a result, if you suspect that you are developing ITB syndrome, it is best to avoid downhill running.

Typically, a runner who is experiencing ITB syndrome will be unable to run due to extreme pain. However, a runner may still be able to run provided he or she runs on an incline or indoors on a treadmill set at an incline.

Because the pain associated with ITB syndrome is often not present when NOT running, athletes will often avoid seeing a doctor.

ITB syndrome is easy to diagnose. Seek care right away to avoid a lapse in running.

Typical Symptoms Of ITB Syndrome Are:

1. pain on the outside of the knee joint which may begin as a stinging or needle like pricks that are often ignored…. this usually progresses to pain every time the heel strikes the ground during running or walking down steps

2. a snapping or popping sound at the knee joint

3. swelling where the band crosses the outside of the knee joint or below the knee where it attaches to the lower leg

4. pain radiating along the course of the ITB from the hip to the knee

What Causes ITB Syndrome????

ITB problems are usually caused by a combination of issues including poor training habits, poor flexibility of muscles, decreased isolated gluteal muscle strength and mechanical imbalances in the body involving areas such as the low back, pelvis, hips and knees.

Training Errors:

Training errors may cause runners to develop iliotibial band syndrome symptoms. If a runner is training for a race and increases his/her mileage too quickly in preparation, he/she is at risk for developing ITB syndrome.

ITB problems seem far more likely in less experienced runners. A recent study in Medicine and Science in Sports and Exercise found that runners who had higher training mileages, meaning they were slower, as well as those who swam, were far more likely to develop ITB syndrome.

Triathletes who are at greater risk for ITB syndrome as they are usually less skilled runners and will spend a lot of time swimming.

Running on the same side of the road repetitively can cause one leg to always be higher than the other causing the pelvis to tilt and put stress on the ITB as a result.

Running downhill is stressful for the ITB as it has to work harder going downhill to stabilize the knee.

Tight Muscles:

Tight piriformis, hamstring and quadricep muscles will cause more snapping of the ITB over the outside of the knee joint.

Alignment Issues:

Runners with a leg length discrepancy are especially susceptible to developing ITB syndrome because the pelvis has to tilt to accommodate for the leg length difference and this puts stress on the ITB.

Runners who are bowlegged are also at risk for developing ITB syndrome. This type of leg alignment will cause the ITB to become excessively tight leading to friction and irritation of the band as it moves back and forth at the outside of the knee joint.

Runners who are over pronators are at risk for alignment issues up the leg that could potentially cause ITB syndrome.

How Is ITB Syndrome Treated????

If caught early enough ITB problems can be dealt with quite easily...

It is important to seek the care of a physician for a diagnosis of ITB syndrome followed by a physical therapist for rehabilitation. Once a diagnosis of ITB syndrome is made, a doctor can prescribe anti-inflammatories for the acute pain or swelling at the knee joint.

A program of physical therapy should be initiated immediately and will include:

1. manual soft tissue and joint mobilization to reduce pain and release the tight ITB at both the hip and knee joint

2. stretching of tight musculature in the leg that may be contributing to pain during running

3. strengthening the muscles of the leg to decrease the stress on the iliotibial band

4. manual adjustment of the alignment in your pelvis or legs to even out any leg length discrepancies that would put stress in the ITB

5. running shoe recommendations to maintain good alignment of your feet on the ground and prevent over pronation of the feet during running

6. orthotic fabrication to maintain good foot alignment when running

How Can You Change Your Running Style to Prevent ITB Syndrome?

1. Run in both directions on the same road regularly.

2. Make sure to have your feet a bit of a distance apart when running. Try not to cross one foot in front of the other when landing one leg on the ground. If the landing leg is crossing midline, then you are putting a lot of tension on the ITB of the landing leg.

3. Increase mileage slowly when training for a race.

4. Limit the amount of downhill running that you are doing.


In order to continue to run and prevent running related injuries from occurring or recurring, don’t forget the basics….

1. Stretch and roll the muscles of the leg regularly.

2. Perform isolated strengthening exercises for the gluteal muscle group and the hamstrings as weakness in these two muscle groups may cause stress on the ITB.

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