Iliotibial Band Friction Syndrome 101
The iliotibial band (ITB) is a tough fibrous tendon that extends from the outside of the pelvis down and along the outside of the thigh all the way to the upper part of the shinbone. The purpose of the band is to provide stability for the knee, but it can become irritated because of friction between the ITB and the bottom of the thighbone (femur). Iliotibial Band Friction Syndrome (IBFS) is one of the most common causes of knee pain in runners and cyclists.
How It Happens
Repeatedly running on the same side of a sloped road can lead to friction, irritation, and inflammation of the iliotibial band. This causes a tilt in the pelvis and one foot strikes the surface below the other. This places more than the usual amount of stress on the ITB. There can be other causes of the condition, including repetitive bending and straightening of the knee (such as in cycling), anatomical problems such as bowed legs and differences in leg length, excessive pronation (rolling inward) of the foot and ankle, a lateral tilt to the pelvis and weak or tight gluteal or quad muscles.
By the Numbers
Percentage of all overuse injuries sustained by runners attributed to IBFS.
3 to 5
Number of days needed to recover from mild cases.
4 to 6
Number of weeks needed to recover from severe cases.
4 to 8
Percentage of distance runners who sustain IBFS injuries.
Who’s at Risk
Runners, cyclists, and military personnel are the persons most susceptible to Iliotibial Band Friction Syndrome, but it can also affect skiers, aerobic exercisers, weight lifters, and racquet sport athletes.
- Tight feeling on the outside of the knee that becomes a burning or stinging sensation when you run
- Pain on the outside of the knee after running, cycling or other activity
- Snapping or popping sensation
- Increased pain when walking or running downhill
- Increased pain when getting out of a car
- Pain that subsides when not running
- Walking with a stiff leg to relieve the friction
- Take a break from the activity that causes the pain, but continue to train in activities that do not stress the ITB (swimming, walking, cycling).
- Apply ice packs to the knee for 15-20 minutes, 3-4 times a day.
- On the advice of a physician or physical therapist, stretch the iliotibial band for 20-30 second periods, 4-6 times a day. (Stand next to a wall, place your right hand against the wall, cross your left leg in front of your right leg and gently push your hips toward the wall).
- See a sports medicine physician if symptoms don’t subside within two weeks.
Mild cases may be resolved within 3-5 days after beginning a rest-ice-stretching program, but severe cases may last four to six weeks.
Incorporate these exercises, courtesy of Athletes’ Performance physical therapist, Jennifer Lewis, into your comeback routine:
Ask your doctor about running with shoe inserts (orthotics) to change the position of the foot during physical activity.
How to Avoid It
- Warm up slowly and replicate the type of movement you will use in the sport.
- Increase training intensity gradually—no more than 10 percent each week.
- Avoid repeatedly running on a banked surface or other activities that appear to be associated with the injury.
- Alternate directions on the same road.
- Wear shoes when you are training or competing that provide adequate lateral (side to side) support.
Perform the following dynamic exercises to warm up before training or sports.
- Lateral squats
- Glute Bridge With Adductor Squeeze
- Mini Band Walks - Lateral
- Mini Band Walks - Linear
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- Jennifer Lewis, PT, DPT, ATC, Performance Physical Therapist, Athletes’ Performance, Phoenix, Arizona
- American Running and Fitness Association
- British Journal of Sports Medicine
- Journal of the American Orthopaedic Association
- Penn State College of Medicine