Iliotibial Band Syndrome

Posted on 03 Jan 2011 21:27

By Maria Rainier

Although sometimes associated with the elderly, iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) commonly affects the thighs and knees of runners, cyclists, hikers, and weight lifters. Squats, in particular, may cause this often acutely painful injury, providing a good case for proper form and adequate warm-ups and cool-downs.

ITB function

The iliotibial band—also known as Maissiat’s band) is the longitudinal fibrous reinforcement of the fascia lata on the outside of the thigh. It reaches from outside the pelvis to over the hip and knee, insterting itself just below the knee. Damage to this band is one of the leading causes of lateral knee pain in runners as it is critical to knee stability during physical activity. The band becomes irritated and inflammation as it repeatedly rubs over the lateral femoral epicondyle.

Symptoms of ITBS

Most commonly, ITBS affects the knee, causing a stinging feeling above the knee joint either on the outside of the knee or entirely along the length of the band. It can even cause swelling where the band moves over the femur. This pain may not occur immediately or even quickly; most runners affected say that it occurs midway or at the end of a jogging session, gradually intensifying with increased or prolonged activity wherein the foot strikes the ground. The pain may persist after cessation of the activity and even during rest.

Cases wherein people are affected in the thigh are less common but the pain may be as acute as those affected in the knee region. Those with ITBS in the hip are less likely to be athletes and more often elderly or pregnant women (connective tissues loosen during pregnancy, which may present problems as she gains weight). Avid stretchers like yogis, however, may experience ITBS in the thigh from applying too much pressure to the hip area, such as during stretches in which the legs are spread.

Unfortunately, as it is less common, ITBS in the thigh is less studied, and fewer treatments are offered by physical therapists and medical personnel.


ITBS is usually acquired with repeated abuse to the region in question, not from a singular and specific incident. Proper form during weight lifting and training of any kind, as well as avoiding the following habits, will help keep the condition at bay:

  • Habitually running on a banked or crowned surface (which bends the downhill leg inward, causing stretching of the ITB against the femur)
  • Insufficient warm-up and cool-down
  • Excessive up-hill and down-hill running or using stairs, to include hiking
  • Rowing
  • Cycling “toed-in”

Certain health and anatomical conditions may also lead up to ITBS:

  • High or low arches
  • Supination of the foot
  • The force at the knee when feet strike ground
  • Uneven leg length or bowlegs
  • Weak hip abductor muscles

Treatment and activities to avoid

If symptoms of ITBS are experienced, those affected should immediately rest, ice, compress, and elevate the affected area (RICE, a first aid measure) to reduce inflammation and thus pain. If ITBS is suspected or confirmed, ongoing therapy should ensue and consist of gentle stretching and heating, cooling, or both (contrast therapy) of the affected area.

Arguably the most effective stretch is by standing with feet shoulder-width apart and bending at the hip, leaning directly to the side opposite of the affected leg. Cross the legs for increased stretching, but be gentle and slow. Simply walking through water and experiencing full range of motion within water may also improve the condition significantly.

Professional help should be sought if the condition is bothersome or interferes with daily activities. Massage therapy may be beneficial by removing scar tissue (one can do this at home with gentle use of a foam roller). An ultra sound machine may help as well, followed by electrode stimulation, although these treatments may become costly. Physiotherapists and athletic therapists will provide the best solutions. While surgery is an option for extreme cases, it should remain a last and heavily-contemplated resort.

While symptomatic, the following activities should be avoided to prevent pain and further injury:

  • Running and cycling
  • Weight lifting, like deadlifts or squats
  • Stair climbing, hill climbing, hiking, mountaineering
  • Court sports such as tennis or basketball
  • Martial arts and gymnastics, extreme stretching
  • Parkour and other extreme sports

About the Author

Maria Rainier is a freelance writer and blog junkie. She is currently a resident blogger at First in Education, where recently she's been researching kinesiology degrees and other degree programs. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.

Sources Consulted

1. Fullem, Brian, DPM. “Beating the Band: New Treatment for IT Band Syndrome Yields Results.” Running Times Magazine. May 2004.

2. Pribut, Stephen M., DPM. “Iliotibial band syndrome.” 16 Dec 2010.

This page created 03 Jan 2011 21:27
Last updated 17 Jul 2016 21:32

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