Iliotibial band syndrome (ITB)

Iliotibial band syndrome (ITB) - An MSK Therapy perspective

Iliotibial Band Syndrome - An MSK Therapy perspective

Many active and non-active people have no doubt encountered Iliotibial Band (ITB) pain, at some point in their life. Excessive, ITB tension can create multiple problems within the "Kinetic Chain" and these can lead to other injuries (see the related articles section). Another name of ITBS is “Runner’s Knee”, as it frequently affects runners and the knee. Confusingly, Patellofemoral Syndrome is also often called “Runner’s Knee” and "Rowers Knee", and the two conditions affect different parts of the knee. Many Sports Injuries have alternative names due to such injuries commonly occurring in certain types of sport. Many sports involve repetitive motions, which can easily lead to injury and inflammation due to changes in Biotensegrity

Anatomy and the ITB

The Iliotibial Band is a thick band of “fascia” which runs along the lateral (outside) portion of the thigh to the knee. Fascia is a type of tough connective tissue, consisting mainly of collagen fibres, which look like candy floss, cotton wool or spider web silk under magnification. Fascia permeates all tissues within the body and provides many functions including structural and biomechanical. There are also specific sheets of fascia throughout the body which separate muscles and internal organs. The fascial network also helps transmit mechanical tension and supports particular movements. Fascia also provides shape to muscles, reduces friction between these structures and is thought to have sensory capabilities be they biochemical or neurological. Fascia is also an elastic material, and these properties can be used to store and release such elastic potential energy. Fascia is the translucent material that one sees when cutting up meat. For example, the chicken breast has a thin fascia covering, and there is also fascia between the breast and tenderloin meat. The fascial material is particularly slippery and robust when fully hydrated, which are essential factors concerning correct functioning. Muscles will not be able to slide across each other efficiently if the fascia is dysfunctional for any reason.

The Iliotibial Band attaches to the Tensor Fascia Latae (TFL), (not an exotic type of coffee). The TFL also has a fascial attachment to the Gluteus Maximus muscle. The diagram below demonstrates how these muscles are related and connected. The white sections between the muscles are the fascial connective tissue.

Image of the Iliotibial band

Image of the Iliotibial band

Images produced with kind permission of from Essential Anatomy 5

(Copyright © 2018 - 2022 3D4Medical. All rights reserved.)

Possible Iliotibial Band Syndrome Symptoms

ITB Syndrome “Runner’s Knee” is a fairly common problem for runners and is usually characterised by:-

  • Lateral (outer) knee pain
  • Pain that is made worse by running or knee bending activities (repetitive)
  • Possible swelling and tenderness on the lateral aspect of the knee.
  • Gradual symptom onset provided no apparent trauma.

Possible Causes

There are many possible causes for Iliotibial Band Syndrome, such as:-

  • Trauma affecting the knee.
  • Muscles imbalances due to muscular dysfunction.
  • Changes in general biomechanics, affecting the kinetic chain.
  • Footwear.
  • Changes in training (speed, duration, terrain).
  • Failing to warm-up and or cool-down.

Professional help and identifying the cause

For any form of treatment to be effective, one first needs to identify the cause of the problem, rather than just treating the symptom. Regarding treatment, it is essential to not look at the Iliotibial Band in isolation and to bear in mind the Iliotibial Band is not a muscle. Hence, it has always seemed rather pointless, not to mention painful, to use a Foam Roller to in effect try and stretch a thick band of fascial tissue. The foam roller article discusses the Iliotibial Band and correct foam roller usage in more detail. Much like ligaments, the fascia is operating partially in a structural fashion, though clearly effects function too and people tend to avoid deliberately stretching ligaments (another type of collagen-based connective tissue).  However, fascia also has elastic potential and the ability to store said energy while being stretched, hence another reason not to bother trying to stretch it. The energy from the stretch will just get saved until the stretch is released and so serves little purpose. From a professional point of view, the author has never seen a case of Iliotibial Band Syndrome in the time that he has been treating musculoskeletal conditions (since 2006) that was caused by the Iliotibial Band. The Iliotibial Band tension was just the symptom in every case, and a tight Iliotibial Band can create rubbing on the lateral aspect of the knee and or hip. Repetitive motions and friction usually lead to microtrauma, inflammation and pain. Pain often leads to the body to subconsciously adopting pain avoidance strategies, which can affect other aspects of the body and kinetic chain (see the adaptation article for a more detailed explanation). Issues with the knee, ITB and hip can also have relevance to lower back pain.

In cases of Iliotibial Band Syndrome, the author has consistently found there to be both structural and functional changes resulting in irritation to underlying tissues. By structure, the author is referring to joint-structure mechanics and function relates changes in compressive and tensional forces within soft-tissues. There is frequently a “chicken and egg” situation, as structure affects function and vice versa. To date, it has usually been possible to resolve Iliotibial Band Syndrome in one treatment, through a combination of musculoskeletal techniques (for structural aspects) and soft-tissue therapy (for the functional component). The soft-tissue methods the author tends to use are advanced Myofascial release techniques with their origins in Osteopathy. Hence, it is worth finding a professional and the article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective provides some hints and tips for finding a consumer-centred practitioner.


General stretching can often give some temporary relief, though it tends not to address the actual cause, which could be anywhere in the “kinetic chain”. Self-massage Foam Rollers and self Trigger Point Therapy (TPT) can also prove useful and give some relief. However, it can often be quite difficult to apply either self-treatment technique correctly to tissues. Also, one needs to have self-diagnosed the actual cause of the problem, before treating the identified tissues. Ideally, one should seek a suitably qualified professional, who can then identify and address the cause of the ITBS symptoms.

The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

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About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession, due to a planned move back to Australia and where is training and education are not recognised. He no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to both health's physical and mental aspects. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught as a senior course coach at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the consumers he sees and has treated over the last 15 years. He has extensive experience treating chronic pain and work and sports-related musculoskeletal injuries. Terry is still very active and enjoys distance running, kayaking, mountain biking and endurance-type activities.