PT Tip of the Month Archive

Iliotibial Band Syndrome (ITBS)


The iliotibial band (ITB) is a thick tissue or fascia that runs along the outside of your thigh.  The ITB begins at the top of your hip and attaches to the tensor fascia lata, gluteus medius, and gluteus maximus muscles.  It then passes down the outside of the thigh and attaches to the tibia (shinbone) just below the knee. The primary function of the iliotibial band is to provide stability to the outside of the knee.

What is ITBS?

Iliotibial band syndrome (ITBS) is an overuse injury that results from repetitive rubbing of the distal (lower) part of the ITB over a bony prominence along the outside of the knee called the lateral femoral epicondyle.  As the knee bends, the ITB is pulled backwards over this bony prominence and is then pulled forward once the knee straightens out.  Repetitive bending and straightening of the knee produces friction and can result in irritation of the ITB. 


Iliotibial band pain is typically described as being “sharp” and is felt along the outside of the knee with repetitive weight bearing activities such as running, cycling, weight lifting, and jumping. Walking generally does not reproduce the pain along the outside of the knee, but going up or down stairs often can. When pressure is placed along the outside of the knee, there is usually tenderness (especially if the knee is bent at a 30 degree angle).


There are a number of different intrinsic factors, or internal causes, which can predispose you to developing ITBS.  The most common include:

  • Weakness of the hip / knee musculature          
  • Decreased flexibility
  • Tightness of the ITB
  • Leg length discrepancy 
  • High arches or flat feet
  • Bow-legged or knock-kneed 
  • Excessive pronation / poor foot mechanics

There are also a number of extrinsic factors, or external causes, of ITBS including:

  • Sudden increase in training distance or intensity
  • Abrupt change in running surfaces
  • Running downhill or on cambered (sloped) tracks
  • Improper warm-up / cool-down
  • Old running shoes


The key to preventing the progression of ITBS is to stop performing all aggravating activities. Applying ice to the outside of the knee can be an excellent way to decrease inflammation and relieve pain. Initiation of a conservative stretching and strengthening program, specifically to those lower extremity muscles attached to the pelvis, is very important for long term relief. Over-the-counter NSAID’s such as ibuprofen can also help.  Cross training with other aerobic activities may be possible as long as you do not experience pain during or after.  

If you feel that you have iliotibial band syndrome, please contact one of our two locations.  Our licensed physical therapists can help determine and correct the factors that have caused your injury.
33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282