Iliotibial band syndrome

The iliotibial band (ITB) is a band of connective tissue that runs down the outer part of the knee. Iliotibial band syndrome (ITBS) is a common knee injury that normally results in pain and tenderness over the lateral aspect (outer side) of the knee.

Pain arising from ITBS is usually the result of overuse. Pain is commonly the result of sensitisation of the structures of the lateral knee such as the iliotibial band and iliotibial bursa. Sensitisation may occur as a result of repeated pressure and an associated inflammatory response. In some instances, pain may develop after a trauma. Large tears/damage to these structures are rare, however in cases where significant trauma has occurred imaging maybe appropriate.

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Causes and symptoms

Causes of ITBS

Pain is most commonly the result of overuse/sudden increase in training load which results in repeated friction to the lateral aspect of the knee. This repeated friction can result in some of the soft tissues in this area becoming sensitised. Often this can be successfully managed with conservative treatment with no long-term implications. ITBS predominantly occurs between the age of 15–50. It is more common in physically active individuals, primarily endurance exercises such as runners and cyclists. 7–14% of runners develop ITBS.

Symptoms of ITBS

Common symptoms include:

Lateral knee pain after an increase in training/activity
Pain that starts around the same distance or duration of an activity
Pain gets worse with activity

Diagnosis of ITBS

Diagnosis can be made from clinical assessment. Imaging is not particularly useful to guide management but a specialist clinician may request a scan if symptoms do not improve with appropriate treatment.

Self management of ITBS

Managing training load

This is key to prevent recurrent aggravation of symptoms.

Weight loss

If you are overweight you are putting extra load through your joints. This will be contributing to your condition. Therefore losing weight will improve your symptoms.

There are useful tools to find out if your weight is contributing to your arthritis and advice on losing weight on the NHS website:

BMI calculator Weight loss plan Exercise advice

Ice

Place an ice pack over the area of discomfort. Place a material between your skin and the cold object. Use this for no more than 20 minutes consecutively.

Anti-inflammatory tablets or gels

If you are unsure about taking anti-inflammatories please speak to your pharmacist or GP.

Footwear

Cushioned and comfortable footwear will likely reduce impact and relieve symptoms

Taping

There are various taping methods which may offer some symptom relief.

Exercises for ITBS

Exercise 1: bridge

Lie face up on the floor, with your knees bent and feet flat on the ground
Keep your arms at your side with your palms down
Lift your hips off the ground until your knees, hips and shoulders form a straight line
Squeeze your buttocks
Hold your bridged position for a couple of seconds before easing back down

Exercise 2: hip abduction in standing

Stand sideways
Make sure you are supported
Keep your knee straight
Take your leg out to the side
Repeat

Exercise 3: side plank

Lie on the floor, on your side
Support your body weight on your elbow, which should be directly under your shoulder. Straighten your body and legs.
Your feet should be together, and your hips should be resting on the floor
Place your top hand on your top hip
Slowly lift your hips off the floor then lower back down

Exercise 4: side plank with leg lift

Lie on the floor, on your side, support your body weight on your elbow
Your elbow should be directly under your shoulder
Straighten your body and legs
Your feet should be together, and your bottom hip should be resting on the floor
Place your upper hand on your top hip
Slowly lift your hips off the floor and raise your top leg so that your legs are spread apart
Slowly bring your feet back together
Repeat

Exercise 5: chair squat

Stand in front of chair of an appropriate height (a lower chair increases the difficulty and a higher chair is less difficult)
With your feet about shoulder width apart, sit with your hips back as if to sit into a chair whilst raising your arms front of you
Touch the chair with your bottom and then return to standing whilst lowering your arms

Exercise 6: single leg mini squat

Stand on one leg with the other leg stretched out in front of you
Your heel should be slightly off the ground
Slowly bend the knee going into a single leg squat position
ALL of your weight should be on this leg
Return to the starting position

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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