All About Iliotibial Band (IT) Band Friction Syndrome

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All About Iliotibial Band (IT) Band Friction Syndrome

IT Band Friction Syndrome is a common repetitive strain injury often seen in runners caused by excessive friction between the IT Band, the bursa and the bony prominence on the outside of the knee (lateral epicondyle). The pain is typically on the outside (lateral) portion of the knee and generally occurs more in males due to the larger lateral epicondyle bone and IT Band. This is an overuse injury that commonly occurs in runners, hiking and excessive walking.

Possible Causes:

  • Trauma
  • Training errors like sudden rapid increase in distance
  • Inadequate warm-up
  • Anatomical factors like thin individuals with large prominent femoral condyles and tight IT Bands are susceptible
  • Over pronation
  • Genu varum (varus deformity in the knee)
  • Leg length discrepancies (one leg longer than the other)
  • Excessive tightness of the IT Band in runners and lack of stretching
  • Excessive internal rotation of the tibia on the femur
  • Running surfaces: switching to indoor running or running on concrete

Some signs and symptoms of IT Band Friction Syndrome include pain or IT Band Syndrometenderness over the outside of the knee on the bony area called lateral epicondyle. Other symptoms include swelling or thickening in the same area or pain with the knee flexed to about 30 degrees while applying full weight on the affected knee.  Other signs include feeling relief walking with your knee held in full extension, knee aggravation when walking downhill, and oftentimes there is a “clicking” discomfort in the lateral knee. The pain is usually worse going down stairs. 20% of IT Band issues occur bilaterally (both legs).


Make sure you see a licensed Physical Therapist with experience treating athletic injuries such as IT Band syndrome. Don’t ignore the symptoms and understand that it is crucial to start off resting, icing (or using ice massage techniques) and getting your gait assessed by the PT.  That way you can assure you are using the proper footwear and test the possibility you may need to correct your running style. Here are some of the things a PT will be prescribing when undergoing treatment for ITB syndrome:

  • Rest
  • Ice or ice massage
  • Myofascial release
  • Foam roller and/or massage stick
  • NSAID’s (Nonsteroidal anti-inflammatory drugs) recommended by your Doctor
  • Ultrasound
  • IT Band stretching
  • Orthotics if necessary
  • Correction of leg length discrepancy (i.e. a heel lift)
  • Education: includes no running for 6 weeks: running permitted only if pain free and gradually increase distance, ice and stretch before workout, avoid hills, shorten stride, run on alternate side of road, make sure you have proper footwear and get your shoes properly fitted
  • Correction of biomechanical factors (i.e. running style or pattern)
  • Very rare cases require surgery

Author: Avi Bregman, PT, MPT


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