One of the most common running injuries we see at our practice is iliotibial band (ITB) syndrome. It often sneaks up gradually, starting with a minor niggle and growing into pain that makes running feel impossible. However, if you know what to look for, you can identify the signs early and prevent them from worsening.
What is ITB syndrome?
The iliotibial band (ITB) is a thick band of connective tissue that runs down the outside of your thigh, starting at the hip and attaching just below the knee. Its primary function is to help stabilise the knee as you move.
The ITB is closely linked with several muscles:
- Gluteus medius: An important hip stabiliser that helps control side-to-side movement when you run.
- Tensor fasciae latae (TFL): A small muscle at the front of the hip that feeds directly into the ITB.
- Vastus lateralis: The outer part of the quadriceps that lies underneath the ITB and can contribute to tension along its length.
These muscles connect to or interact closely with the ITB, tightening and influencing the band when they contract. When you run, the ITB slides over the bony part of the thigh near the knee. If the band becomes too tight or if the muscles around the hip and thigh are not supporting it well, irritation builds up. This irritation can lead to ITB syndrome. Because running involves repeated bending and straightening of the knee, the ITB is constantly strained, making runners especially prone to this condition.
What causes ITB pain in runners?
There is not just one cause of ITB syndrome, but rather a mix of factors that place extra strain on the band. The most common include:
- Sudden increases in training load
Building mileage or intensity too quickly can overload the ITB before the body has time to adapt. - Weakness in the hip stabilisers
Muscles like the gluteus medius (located on the side of the hip) and gluteus minimus (a smaller muscle positioned underneath it) help maintain the pelvis' level position and guide the knee during running. When they are weak, the ITB takes on extra strain. - Poor biomechanics
Running form, such as the knee collapsing inwards, can increase the tension placed on the ITB. - Tightness in surrounding muscles
Tight quadriceps (front of the thigh), hamstrings (back of the thigh), or calves can affect how freely the ITB moves. This tension can make the band rub more against the side of the knee. - Training surfaces and footwear
Repetitive running on sloped roads or using worn-out shoes can change your mechanics in small ways that eventually irritate the ITB.
The signs to watch out for
The sooner ITB irritation is recognised, the easier it is to treat. Common warning signs are:
- Pain on the outside of the knee
At first, this may feel like a dull ache that comes on during or after a run. Over time, it can become a sharper pain that makes running, and sometimes even walking, uncomfortable. - Tenderness on the outside of the thigh
Sensitivity when pressing along the ITB, particularly just above the knee, indicates that it is irritated. Some runners also notice discomfort when climbing stairs or sitting for long periods with bent knees. - Pain that shows up after a certain distance
ITB symptoms often appear once you have reached a particular distance – for instance, only after the 5 km mark – no matter the pace. - Worsening on downhills
Running downhill can exacerbate the pain because the ITB has to work harder to stabilise the knee. If your discomfort increases during descents, it is a strong indicator that the ITB is involved. - Clicking or snapping feeling
Occasionally, the ITB can cause a snapping sensation at the outside of the knee. Even if it is not painful yet, it usually indicates that irritation is developing.
Take early action
ITB syndrome rarely improves with rest alone, and ignoring the signs often results in longer recovery times. At Hein Viljoen Physiotherapy, we use a combination of the following treatments for ITB syndrome:
- Progressive strengthening and loading: Targeting the hip abductors and stabilising muscles with controlled exercises that gradually help the ITB and surrounding tissues adapt, reducing strain and building resilience.
- Manual therapy: Releasing tension in the ITB and surrounding muscles to ease discomfort and improve mobility.
- Dry needling: Releasing trigger points and reducing muscle tightness in the hip and thigh.
- Shockwave therapy: Stimulating healing in irritated tissues, especially when symptoms have been persistent.
- High-power laser therapy: Promoting tissue repair and reducing inflammation to speed up recovery.
If you are consistently getting pain on the outside of your knee, particularly if it follows a familiar pattern during runs, it is time to see a physiotherapist.
Listen to your knee before it shouts louder – schedule a session at Hein Viljoen Physiotherapy in Cape Town.
