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Iliotibial Band Syndrome

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The Iliotibial Band (ITB) is a strong band of connective tissue that runs from the pelvis, along the outside of the thigh to the tibia (shin bone) crossing 2 joints – the hip and the knee. It is an important stabilising structure of the lateral part of the knee during flexion and extension. Alongside the associated muscles, it also acts to extend, abduct and laterally rotate the hip.


It is the longest tendon in the body but as it is anchored to the femur, it is not free moving. The main muscles that attach into it are the Tensor Fascia Latae (TFL) and the Gluteus muscles. The tendon then attaches to the femoral condyle – a bony protuberance on the lower part of the femur, and the lateral tibia.

Signs & Symptoms

  • Pain is typically reported in the outside of the thigh just above the knee and is frequently described as a ‘burning’ feeling.
  • Symptoms may radiate up and down the outside boarder of the leg.
  • Worse with repetitive knee bending-straightening actions such as walking, running, stairs.
  • Some patients report a ‘flicking’ or ‘snapping’ sensation which can be heard.
  • Swelling and redness may be present in the symptomatic area.


ITB syndrome is an overuse injury often caused by running and it is one of the most common running injuries. Inflammation or irritation can occur as the ITB passes over the bony prominence of the femoral epicondyle during flexion and extension. It has been suggested that during extension, the band runs anteriorly to the femoral epicondyle and during flexion it runs posteriorly. However, it has been put forward that this is an illusion due to the changing tension in the anterior and posterior fibres during movement (Fairclough et al., 2006). Generally the pain is felt on the outside of the knee near this point.


ITB syndrome can be caused by muscle tightness or strength imbalances in the leg or hip, long distance running due to repetitive friction, a sudden increase in activity e.g. running frequency or increased mileage, or altered biomechanics. Although commonly considered as a running injury, it can be caused by other physical activities such as swimming or climbing.

Assessment & Diagnosis

Your Physio will ask for a history of your symptoms proceeded by carrying out a clinical examination so that a precise and timely diagnosis can be given to ensure the most effective treatment can be put in place immediately. Your Physiotherapist will work closely with you to set individualised treatment goals for you to aim at and will regularly re-assess you to measure your progress and make any necessary modifications in your treatment.


One misconception regarding the ITB is that it can be stretched. An intensive stretching study by Wilhem et al. (2017) showed that the ITB could only be stretched a maximum of a few millimetres but then was not likely to remain in that slightly lengthened state and this was by applying much heavier forces than can be applied by a stretch during exercise. Stretching is therefore unlikely to impact on the ITB itself but the muscles associated with it can be stretched. TFL – being the muscle that mostly controls tension on the ITB, can be stretched by adducting the hip towards midline or across the body and pushing the other hip out. The gluteal muscles can also be stretched to alleviate some of the tightness and symptoms.


Initial treatment is to reduce inflammation and pain by resting and using a combination of ice and anti-inflammatories if appropriate. A reduction or rest from training may be necessary, followed by a gradual return to normal activity; all of which your Physiotherapist will explain and guide you on.


Strengthening your hip and gluteal muscles is crucial in recovery and preventing further repercussions. Your Physiotherapist at Pure can provide you with a personalised and progressive exercise plan which will assist you in getting back to training and normal activity. Hands on treatment techniques may also be used to reduce pain and increase the flexibility of soft tissues identified as over active. You will be given ongoing support and guidance so that you can effectively manage your symptoms and prevent re-occurrence.


Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., Best, T.M. and Benjamin, M. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of anatomy208(3), pp.309-316.


Wilhelm, M., Matthijs, O., Browne, K., Seeber, G., Matthijs, A., Sizer, P.S., Brismée, J.M., James, C.R. and Gilbert, K.K. (2017). Deformation response of the iliotibial band-tensor fascia lata complex to clinical-grade longitudinal tension loading in-vitro. International journal of sports physical therapy12(1), p.16.

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