A Guide To: Iliotibial Band Syndrome

A Guide To: Iliotibial Band Syndrome

Iliotibial Band Syndrome is a common injury that causes pain on the lateral aspect of your knee and that can be caused by running and cycling, between others.

Our Senior Physiotherapist, Victoria Reboredo runs through her complete guide to the condition and how it can be beaten.


How does this common, painful knee injury feel?

For most runners, there’s a familiar, awful sensation that can strike at any time. From a short warm-up jog to the deepest stages of a marathon, a shooting pain in the side of your knee can make every step painful and feels like your body might have undergone a career-ending malfunction. This is thanks to one of the most seemingly minor – yet excruciatingly painful – complaints known to sportspeople, named iliotibial band syndrome.


What are the key symptoms of ITBS?

The most common is the sharp pain described above, commonly in the outside edge of your knee. This can sometimes also be swollen, with a palpable ‘snapping’ or friction sensation when you move the joint. All movement can cause pain, but the key spot is when the knee is bent at 30 degrees – so bending, extending the leg or going downstairs is particularly painful.


What causes it?

The most common trigger is the most simple, says Reboredo: “Training too much, too soon.” But an overall muscular imbalance in the body can also be an issue. “ITBS is normally related to weak hip abductors,” she explains. “The hip abductors are the muscles that allow your hip to move outwards/laterally when your leg will move laterally/away from the midline of the body. In patients with ITBS we tend to find weak gluteus medius. Sometimes the glute can be strong in isolation, but there can be issues with its activation or its capacity to contract and relax at a specific pace.” Poor running form or instability, worn-out shoes, or the aggravation of previous injuries can also be an issue. There’s also some suggestion that muscular tightness can be an underlying cause, but aggressive stretching and foam rolling can further inflame injuries, so these should only be undertaken after a physio consultation.


Who is most prone to it?

“ITBS can happen to any age and gender,” says Reboredo. “It is normally related to practicing sports that require continuous flexion-extension of the knee to around 30 degrees, including running and cycling. It is common in marathon runners, as well as speed runners. ITBS can also happen to athletes participating in tennis, soccer, skiing, rugby and weightlifting.”


What can you do pre-emptively to avoid ITBS?

Reboredo pinpoints over-training as a key trigger for ITBS.  “Avoid doing too much too soon,” she warns. “Increasing your training variables too fast, or even more than one at the same time (speed, miles, number of sessions per week, inclines/hills, etc) can exponentially increase your injury risk.” For training she advises building in some hip abductor strength training, while forward-planning for your runs is essential. “Be mindful of your training route. How many inclines/hills do we have? Is it a soft or a hard surface? Is it a regular or irregular surface? It's not the same running 20 minutes on concrete, then running 20 minutes on grass or sand. Variability is good, but we must ensure we introduce these variables progressively as explained above, to get the most out of the training.”


And if ITBS does strike?

Reboredo stresses that as every body is different, there isn’t one off-the-peg solution to ITBS.  A full physical assessment needs to take place to discount any serious underlying issues, followed by an analysis of other aggravating factors – training habits, diet, previous injuries, general health levels etc. From there, an individually-tailored programme of recovery can be built, utilising everything from hands-on treatment to kinesiotaping and dry needling, plus a longer term plan to prevent the condition reoccurring. This means looking at a “tailored exercise program, strength and conditioning plans, warm-up and cool-down plans, changes to your training habits or review of your training plan, including specific factors including your pace, resting days, equipment, frequency of sessions, flat or hill sessions and if you're training for speed or endurance.” With this structure in place, your training should be able to resume safely, quickly– and without any reoccurrence of that dreaded knee pain.

For more advice on common running injuries and to begin your treatment plan, visit our physio page here and book your appointment.