Lateral Knee Pain Part 1 – What is Iliotibial Band (ITB) Syndrome?


  • An overuse injury characterized by pain on the outside part of the knee
  • Pain can be experienced during activity or at rest with the knee bent
  • Common in runners but also seen in hikers and cyclists
  • Pathology
    • Some debate over ‘friction’ and exact pathology
    • Likely some inflammation/irritation of connective tissue on the outside of the knee
  • Anatomy
    • ITB attached to gluteus max and tensor fascia latae (TFL), runs along the length of the femur and attaches to the lateral condyle of the tibia
    • Contributes to lateral knee stability
    • *Very unlikely to be able to stretch it*
    • May behave like a tendon in storing and releasing energy
    • Potential most vulnerable range is 30-40 degrees of knee flexion when ITB may cross lateral femoral condyle

Unmodifiable Intrinsic Risk Factors

  • Age
  • Gender – although yet to be proven it is thought females have a higher likelihood of developing ITBS due to anatomical differences
  • Genu varum (Bow leggedness)
  • May overlap with anterior knee pain/patella femoral pain syndrome

Modifiable Intrinsic Risk Factors (*Best evaluated by a Physiotherapist*)

  • Reduced control of hip adduction/internal rotation
  • Reduced glute med strength
  • Biomechanical abnormalities – foot alignment/pronation
  • Weight (Increased BMI)
  • Muscle imbalance and inflexibility
  • Leg length discrepancy (LLD)
    • A true LLD can be modified with appropriate foot lift orthotic
    • A functional LLD can be modified with better muscular control and/or orthotics if necessary

Extrinsic Risk Factors (*Best evaluated by an MPT Physiotherapist*)

  • Change in loading
    • Return to running or activity after a break
  • Training errors
    • Change in training type (i.e. increased downhills for runners and hikers)
    • Increase in training volume/intensity too quickly
    • Change in training duration
    • Increase in training frequency
    • Change in weekly distance
  • Running style
    • Narrow step width
    • Slower cadence
  •  Footwear – if not supportive enough to prevent over pronation

Treatment…To Be Continued.

***Book with MPT today to start your 1 on 1 individually tailored rehab program to get you back to what you love!***


Brindle, R. A. (2018). Physiological and Biomechanical Factors Contributing to the Hip Adduction Angle in Female Runners (Doctoral dissertation, Drexel University).

Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., … & Benjamin, M. (2007). Is iliotibial band syndrome really a friction syndrome?. Journal of Science and Medicine in Sport10(2), 74-76.

Fredericson, M., & Wolf, C. (2005). Iliotibial band syndrome in runners. Sports Medicine35(5), 451-459.

Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine10(3), 169-175.

Tiu, T., & Craig Van Dien, M. D. Knee overuse disorders.

Meardon, S., & Miller, R. H. A new approach to iliotibial band syndrome in runners.

Meardon, S. A., Campbell, S., & Derrick, T. R. (2012). Step width alters iliotibial band strain during running. Sports biomechanics11(4), 464-472.

Miller, R. H., Lowry, J. L., Meardon, S. A., & Gillette, J. C. (2007). Lower extremity mechanics of iliotibial band syndrome during an exhaustive run. Gait & posture26(3), 407-413.

Nielsen, R. O., Nohr, E. A., Rasmussen, S., & Sørensen, H. (2013). Classifying running‐related injuries based upon etiology, with emphasis on volume and pace. International journal of sports physical therapy8(2), 172.