Iliotibial Band (ITB) Friction Syndrome

What is ITB Friction Syndrome

The iliotibial band (ITB) is a long, thin band of fibrous connective tissue that runs along the outside of the thigh.  It is attached to the Tensor Fascia Latae and Gluteus maximus muscles at the hip, and attaches to the outside of the knee cap (patella) and the lower leg bone (lateral aspect of tibia tubercle). 


Often reported by runners, ITB friction syndrome occurs when there is repetitive friction against the ITB and the bony prominence (lateral epicondyle of the femur) on the outside of the knee, usually when the heel strikes the ground.

What Causes ITB Friction Syndrome?

ITB friction syndrome is usually attributed to altered biomechanics and inappropriate training, such as a sudden increase in training frequency, changes in surface, and even speed. Other causes that have been reported are:

  • Hip abductor weakness
  • Overpronation / flat feet
  • Bow-legged
  • Leg length discrepancy
  • Tight muscles, such as hip flexors and quadriceps muscles

How Do I Know If I Have ITB Friction Syndrome?

Pain usually presents on the outside of the knee, and usually increases with the activity even though there may be a pain-free start. Pain may radiate down the leg, or up towards the hip. As the syndrome progresses, there may even be pain on walking.

How can Physiotherapy help?

An assessment by your physiotherapist can help identify problematic areas such as muscular tightness and weakness contributing to altered running biomechanics. Treatment usually consists of soft tissue release, ultrasound therapy and taping for pain relief, and specific exercises and stretches targeted at restoring hip and knee functions. Time taken to return to sports will depend on the initial severity of the condition, but most do within 6 weeks.