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What is illiotibial band (ITB) syndrome?
Aging, Exercise, Muscles & Joints

What is Illiotibial band (ITB) syndrome?

The Iliotibial Band or the ITB as it is more commonly referred to, is the second leading cause of pain in running. It is also prevalent in other sports such as cycling, basketball, rowing, in the armed forces, and the list continues.

The ITB is a long and strong fibrous band composed of tendon and ligament tissue tracking down the lateral aspect (outside) of your thigh from the crest of your hip just past the knee. Usually this is an extremely useful piece of the jigsaw to your lower limbs’ movement and strength; however like anything we rely on, it can have bad days, weeks or months. Why? Usually because we are asking and doing too much, so the ITB becomes aggravated and less happy with the load.

What exactly is happening? Well the previous belief was that the pain was due to friction. This has been found to be no longer true as the ITB is securely anchored in place. Forget I even mentioned it. Research is finding that ITB pain is more due to a result of repetitive compression of the ITB on the highly innervated underlying fatty tissue.

What are the signs and symptoms of ITB Syndrome?

ITB syndrome can present with a number of different signs and symptoms. At the clinic we have found that a client can present with some our all of those listed below:

  • Sharp lateral (outside aspect) knee pain

  • Insidious onset (sudden / non-traumatic)

  • Pain occurs during activity at a specific point, e.g. 2 miles or 15 minutes into a run / cycle / row

  • Lateral knee pain gradually increases

  • Feels tight and even tighter when moving or running (BUT IT WILL NOT SNAP)

  • Worse on decline or descending stairs

  • Pain when knee is loaded (or even when seated) in a 30 degree flexed (bent) position e.g. repetitive cycling pattern

  • Repetitive movements = running, cycling, full squats, lunges…

What causes ITB pain?

A popular question when experiencing any injury. This can be one point or many, the most common causes are: 

  1. A sudden increase in training load such as:

    1. Just starting a new fitness routine,

    2. Increased mileage on your runs,

    3. Running on different terrain that you are not used to (trail running, hill climbs on the bike or run),

  2. Not giving yourself enough time to recover and adapt from your training.

  3. Biomechanical factors that need addressing like your running gait or muscular weaknesses.

The one thing we can be certain of is that it can hurt like a mother hubbard and be extremely irritating.

How long does ITB pain last?

Injuries take time to recover and ITB pain is no different. As with any injury this depends on the individual, if you follow the recommended advice for ITB irritation and listen to your body. What we do know is you will have to put the work in, adjust your training and you must, MUST do the exercises.

In our clinic and from the experience of over 15 years treating clients with ITB problems in West London, the average recovery time can vary anywhere from 6 weeks to as long as 9 months. The important factor is that you seek professional advice and be proactive in your rehabilitation programme as early as possible. Don’t ignore your symptoms as it will get worse.

How can I fix my ITB pain?

What should we do when something starts to become irritated, painful and unaccepting of the loads we put it through? We should modify, adapt and rebuild. 

Modify the loads = think about reducing the amount of load that you are putting your body through. Do you really need to run 5 consecutive days per week? Does it always have to be 5/8/10km? No. So…

Adapt your plan and train smarter. Include recovery days / taper weeks and remember just because you were once able to cycle every day or run those distances doesn’t mean you can forever. Your body, like you, when it’s working hard, sometimes needs help. So give it the support it needs and strengthen it.

Get stronger – there is an abundance of evidence of biomechanical factors that play a role and those that advocate for increased strength and endurance. For further reading there are a number of articles HEREHEREHERE and HERE.

From what we’ve seen here at Chiswick Physio the key is to increase the strength of all your muscles involved with powering that lower limb machine. Think glutes, quadriceps, hamstrings, calves and that famous ‘core’ everyone is always on about. 


    Key points to ITB pain

    2 key points in managing this that I want you to leave with…

    1. Passive treatment won’t solve the issue

    Do Not Stretch It!

    Do Not Massage It! 

    But it feels tight!.. I’ve done it for years!.. My last physio did it 5-10 years ago … My PT said I should.. I saw it on the internet.

    All of the statements above may be correct but the evidence to back it up is poor or quite frankly not there. 

    I implore you to please put that beloved foam roller away. Drop the massage gun. Stop with the catalogue of stretches. There are no benefits to this and they will only make your pain worse. The ITB is an extremely strong band that is COMPRESSING. These techniques will only add more pressure to a highly sensitive area. They will not make any long-lasting changes and will most definitely cause more pain. 

    Think of it as a bruise. You wouldn’t keep prodding it would you?!

    So why do it to the ITB?

    2. You need to perform the exercises and you need to get stronger.

    Yes, you could rest it. Yes you can try all the fancy new passive treatments out there. Yes you can try and let it settle. But the chances are that as soon as you start running again, you’ll hit the same problem. Don’t be passive. Be active. Get strong and you can’t go wrong. 

    For those of you that are interested in reading further into the prevalence of the ITB in different sports you can have a look   HERE, HERE and HERE.

    We are here for you

    If you’re in pain and would like to talk to us about getting some help, some specialist advice, or if you are looking for a diagnosis, remember we are always here to help you.

    Appointments remain limited and we are experiencing an exceptionally high demand for our physio services since UK restrictions were lifted, so please contact us immediately to avoid a long wait.

    If you would like to get one of our limited slots, please click book a consultation to email or CALL us on 07900603617.

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