Iliotibial Band (ITB) Syndrome


ITB syndrome causes pain on the outside of the knee, and is easily mis-diagnosed as knee pain. The pain is usually a stinging pain where the band inserts into the outside of the knee, but can sometimes be felt the whole way up the ITB. The ITB may also feel very tight. Sometimes there may be swelling on the outside of the knee.

Generally pain is felt after an activity, e.g. after a run, or when you twist your knee if turning a corner. Pain is not always felt during an activity and may increase over time.


The ITB is a thick band of fascia which tracts from the outside border of the knee up over the hip bone and joins into the muscles on the outside of the pelvis.

The band is a key stabiliser of the knee during running.


ITB syndrome may be the result of several factors. The main causes are poor training habits, anatomical differences and muscular imbalances.

The common cause of ITB syndrome is inflammation of the ITB. This often occurs in long distance runners; who repeatedly bend and straighten their legs whilst jogging. As the leg bends and straightens the ITB moves over the lateral femoral condyle (the outside of the thigh bone at the knee) and can cause irritation.

Training Habits Anatomical Differences Muscular Imbalances
Poor warm up/cool down Increased valgus knee angle Weak gluteus medius/ hip abductors
Angled knee due to:

  • “toe-in” running
  • Running on sloped surface
  • Lots of down-hill or up-hill running
Over-pronated feet when running 


Weak core muscles
Breast stroke swimming Dropped arches or high arches Uneven stretching of band, e.g. sitting cross legged lots, sleeping on one side with other leg dropped over
Resting outside of knee against something repeatedly, e.g.: car door, desk Leg length discrepancies
Running with an injury on the other leg; compensatory reactions Bowlegs


If you think you may have ITB syndrome you will need to see a Physiotherapist who will assess you to establish what is causing the pain. Treatment will depend on the individual depending on the cause of the ITB pain, this may include massage, mobilisations, stretches and strengthening work. Whilst you are waiting for an appointment modify your exercise routine so as not to make the injury any worse, ice the area that is painful and see your local pharmacist for pain relief medication. Gentle stretching and use of the foam roller can also help.