Running Injuries - Iliotibial band syndrome (ITBS)

Running Injuries - Iliotibial band syndrome (ITBS)

Iliotibial Band Syndrome (ITBS)

Many active and non-active people have no doubt encountered iliotibial Band (ITB) tension, at some point in their life. Excessive, ITB tension can create multiple problems within the “kinetic chain” and in particular the hip, knee and lower back (see the Biotensegrity article for a more detailed explanation). Another name of ITBS is “Runner’s Knee”, as it frequently affects runners and the knee. However, Patellofemoral Syndrome is also often called “Runner’s Knee”, and the two conditions affect different parts of the knee. Here is a link to the Patellofemoral Syndrome (Runner's Knee, Rower's Knee) article.

Some brief anatomy knowledge, yawn

The ITB 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 ITB attaches to the Tensor Fascia Latae (TFL), (not a 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 3D4Medical. All rights reserved.)


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 ITB 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.


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 ITB in isolation and to bear in mind the ITB 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 ITB 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 ITBS in the time that he has been treating musculoskeletal conditions (since 2006) that was caused by the ITB. The ITB tension was just the symptom in every case, and a tight ITB 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 adopt pain avoidance strategies, which can affect other aspects of the body and kinetic chain (see the Adaption article for a more detailed explanation).

In cases of ITBS, the author has consistently found that dysfunction within the quadriceps and usually gluteal muscles are the actual cause of excessive ITB tension. That said, other muscles can become dysfunctional over time, and indeed other aspects of the “Kinetic Chain” can also be impacted. The author has also seen some cases of patients with structural changes affecting the pelvis, which then have a knock-on effect on Biotensegrity and ITB tension. To date, it has usually been possible to resolve ITBS in one treatment, through a combination of McTimoney Chiropractic (for structural aspects) and soft-tissue techniques. The soft-tissue methods the author tends to use are advanced myofascial release techniques with their origins in Sports and Remedial Massage.


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 next Running Related Article will cover Ankle injuries.

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

Chiropractic and Massage Registrations

All of our therapist's hold relevant professional industry registrations and or memberships. Our principal Chiropractor Terry Davis MSMA holds additional memberships and registrations for Massage Therapy with the Complementary & Natural Health Council (CHNC) and the Sports Massage Association (SMA). He is also BTEC Level 5 Clinical Sports and Remedial Massage Therapy qualified.