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Ilotibial Band Syndrome, commonly referred to as ITBS is a common injury to the thigh, generally associated with running, cycling, and other repetitive exercises/sports.

This overuse injury occurs with repetitive flexion and extension of the knee. Inflammation and irritation of the iliotibial band (ITB – see figure 1) also may occur because of a lack of flexibility of the ITB.

The ITB is a thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is very important to stabilising the knee during exercises such as running. The continual rubbing of the band over the lateral femoral epicondyle (outside of the thigh bone), combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed and painful.


ITBS symptoms are varied, with some athletes experiencing a stinging sensation or an ache just above/outside the knee joint (on the outside of the knee or along the entire length of the ITB) to swelling or thickening of the tissue at the point where the band moves over the outside of the thigh near the knee (see Figure 2). In addition, the pain may also be present below the knee, where the ITB actually attaches to the tibia.

The pain may not occur immediately during activity, but may increase throughout the activity. The pain may sometimes persist after the activity but generally eases with rest. ITBS can also occur where the ITB connects to the hip, though this is less likely as a sports injury.

ITB commonly occurs during the later stages of pregnancy, as the connective tissues loosen and the woman gains weight, each process adding more pressure through the hip and knee.
Some common exercises to avoid if you have or are developing itbs:

  • Running,
  • Stair climbing/ running
  • Deadlifts or squats\
  • Court sports, such as tennis, basketball, or similar.
  • Cricket such as a fast Bowler
  • Cycling
  • Dancing
  • Rowing


ITBS can result from one or more of the following;

  • Increase in training intensity/ overload and training habits: Inadequate warm-up or cool-down
  • Excessive up-hill and down-hill running
  • In cycling, having the feet “toed-in” to an excessive angle
  • Running up and down stairs
  • Increasing the distance of exercise when you are not ready.
  • Running on a banked surface (eg. around the Barwon River)
  • anatomical abnormalities
  • High or low arches
  • Supination of the foot (ie. Causes the “bow-legged” appearance)
  • Uneven leg length
  • Bowlegs or tightness about the ITB.
  • muscular imbalances
  • Weak hip abductor muscles
  • Weak/non-firing multifidus muscle (located deep in the spine)


In the initial stages of acute ITBS (which can be quite painful and debilitating), the RICE regime should be applied (Ie. Rest, ice, compression, elevation) to reduce the pain and inflammation and immediately followed up with an appointment with a physiotherapist.

After proper diagnosis, a range of treatment modalities will take place such as commencing a stretching program which could be combined with massage and dry needling.

Treatment will only be beneficial if the athlete readjusts their training immediately and more importantly in order to prevent ITBS recurrence in future the athlete must progress their training session/duration and intensity very carefully. The Physiotherapist will be able to guide you through a complete structured training program.

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