The Iliotibial Band (ITB)is an extension of the fascia covering the Gluteus Maximus and Tensor Fascia Latae (TFL) that attaches to the lateral (outside) knee at the Tibia.

Iliotibial Band Syndrome

Iliotibial Band Syndrome

The Iliotibial Band (ITB)is an extension of the fascia covering the Gluteus Maximus and Tensor Fascia Latae (TFL) that attaches to the lateral (outside) knee at the Tibia.  Irritation occurs either at the hip or knee when there is excessive tension on the ITB.  Repeated flexion and/or extension as in long distance running may produce inflammation and lead to ITB Syndrome!

This “Band” acts as a stabilizer during running.

Symptoms of ITB Syndrome:

This debilitating repetitive stress injury typically presents with localized pain over the lateral aspect of the knee, lateral, lower thigh, or lateral hip.  Athletes also report increased pain during running but relief with rest in the early stages.  Pain frequently increases with heel strike and with descending stairs and transitioning from sitting to standing.


Causes of ITB Syndrome:

*Gluteus Medius (side gluteal muscle) weakness or tightness! (This one is paramount!)

*Excessive pronation or supination

*Leg length discrepancy and/or pelvic unleveling

*Toed in position in cycling

*Varus Knees (Bow legged pattern)

*Quadriceps tightness (common in distance runners)

*Road Pitch running

*Excessive hill running (up or down)

*Excessive breast stroking in swimming

*Inadequate warm-up or cool-down!

*Excessive wear on outside heel edge or running shoes


Management of ITB Syndrome:

*Active Rest (avoidance of painful activities while remaining fit)

*ICE – 3X/day @ 30 minutes per application

*Correct biomechanical imbalances with adjustments and/or orthotics

*Kinesiotape knee and/or hip

*Physiotherapy – 2X/week (ultrasound, phonophoresis, iontophoresis!!!)

*Myofascial Cupping therapy

*Transverse Friction Massage

*Myofascial release @ Gluteals, Quads, Hamstrings, Gastrocnemius, TFL

*Improve flexibility of hips, quads and hams

*Strengthen Gluteus Medius and Maximus!!!

*Foam Roller @ Quads, Hips, Hams, TFL, ITB, Lower Back


As with many of the RSIs in the athletic arena and especially in the distance realm, ITB Syndrome, once manifested can be difficult to resolve.  This injury requires time and attention due to the nature of the tissue – large surface area spanning two joints (hip and knee).  If this issue has not responded with avoidance and time, consider addressing the kinetic chain – foot-knee-hip-pelvis alignment and also saturating the ITB with penetrating therapies.  Pain is typically the last symptom to show up when there are imbalances that need correction.  Listen to the cues of stress and address any imbalances before they become debilitating, fully manifest injuries.  Prevention is always the best medicine with many of the RSIs encountered by endurance athletes!!

Images: Beth Ohara
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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

One Comment

  1. Paige | April 7, 2014 at 11:15 am

    My doctor recommended a golf ball muscle roller for my ITBS, surprisingly worked very well, check it out!!

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