August 25, 2017

Iliotibial Band Syndrome (ITBS) is a common ailment for many recreational and professional runners. It has an easily recognizable pain pattern that begins at the crest of the hip and descends to the outside of the knee. Although extremely familiar to most runners, it is one of the most misunderstood running related injuries.

What is the Iliotibial Band?

The Iliotibial band (IT Band) is really just a long tendon of the tensor fascia latae and the gluteus medius and maximus. This muscle attaches at the top point of hip and spans about 3-4 inches, before transitioning into the IT Band further down the leg. Ultimately, the IT Band crosses the outside of the knee and attaches to the tibia. Since the IT Band crosses two joints, it can be directly affected by any of the abnormal tissues that surround the knee or the hip. Flexing the knee between 10-15 degrees causes the IT band to maximally tense and relatively migrate backwards which may cause a rubbing irritation on the outside of your knee at the femur’s lateral epicondyle.

Why Avoid Passive Treatments?

Runners are incredibly smart and love to research treatment options. Unfortunately, most online and word of mouth approaches tend to lead runners to passive treatments like icing, ibuprofen/naproxen, foam rolling, generic glute work, or taking time off in order to assuage their symptoms. These options may ease the pain, but will not, however, truly address the underlying cause. It is crucial to look both up and down the kinetic chain, for example, the pelvis and ankle, to find the culprit of ITBS. Although foot issues are often to blame, the hip stabilizers are typically the cause of ITBS.

What Are The Real Causes of ITBS?

Enter the knee’s friends – the gluteus maximus and the gluteus medius are the stars when it comes to hip and knee stability. Abnormal firing patterns in these muscles during dynamic loading activities, like running, can have deleterious effects down the kinetic chain. Normally, the forces created while running would primarily be absorbed by and transferred to the glutes. With insufficient glute recruitment, however, those forces create uncontrolled motion at the hip and knee. Less than ideal knee and hip biomechanics results in abnormal tensioning or pinching of the IT Band. When this happens, runners often complain of pain along the outside of the knee, and extreme tightness along the lateral quad. ITBS likes to rear its ugly head when runners increase intensity and especially as core and hip mobility and strength training are given the backseat.

How Can I Fix it?

So how do you control these aberrant movements and prevent or treat ITBS? The fix is a rehab plan that consists of individualized hip and core stability movements and exercises. Although the foam roller may be effective for massage purposes, the IT Band cannot be lengthened substantially which means foam rolling is an ineffective strategy to stretch the IT Band. Foam rolling may feel good to some runners, but it is not sufficient alone in treating ITBS.

To help with ITBS, consider trying the exercises shown below. These movements specifically address multidimensional hip and core stability. If you do not notice improvements quickly, visit and schedule a personalized functional movement examination by one of our physical therapy doctors.

Remember to take advantage of our referral reward promotion right now! If you refer someone to Forefront Physical Therapy you are rewarded with a $10 Amazon Gift Card! Check out more details about our Referral Reward Program.

Click here and here see studies that examined how the IT Band cannot be truly lengthened by stretching or foam rolling.

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