ITB Syndrome or Runners’ Knee (not just in runners)

The iliotibial band (ITB) is a lateral thickening of the tensor fascia lata. It is a dense fibrous connective tissue running from the tensor fascia lata and gluteus maximus muscles, down the lateral side of the thigh, across the knee joint laterally, inserting into Gerdy’s tubercle on the anterolateral aspect of the tibia.

ITB syndrome is an overuse injury and is one of the most common causes of lateral knee pain within the athletic population. It is particularly common in runners and cyclists, where repetitive flexion-extension is apparent. However, it has also been commonly presented in weightlifters, skiers and soccer players.

Cause  of Injury:

Repetitive friction between the ITB and the lateral femoral condyle is what generally tends to cause this syndrome. However, there is usually some kind of biomechanical dysfunction or muscle imbalance which predisposes the athlete to this type of injury.

Main biomechanical causes include:

·         Weak and/or tight gluteal muscles – most commonly gluteus medius > gluteus maximus;

·         Weak and/or tight piriformis;

·         Tight TFL and ITB;

·         Weak core and pelvic floor muscles;

·         Unstable pelvic control;

·         Dropped medial arch of the foot;


·         Increased mileage;

·         Bad footwear.

When the gluteal and piriformis muscles weaken, in comparison to other muscles such as the hamstring, the hip joint loses its ability to laterally rotate and hold a laterally rotated stable position during lower limb movement. This causes the hip to internally rotate and then the knee to move medially, with the medial arch of the foot often collapsing. This change in the mechanics of the lower limb means that the ITB is put at increased load and thus begins to rub over its bony lateral femoral condyle, which it crosses prior to inserting into the tibia.

ITB syndrome can also be related to weak core muscles and a lack of pelvic stability. These cause reduced lower limb control, putting the joints below in a dangerous position increasing the chance of misalignment, increased regional impact, and thus ITB syndrome.

Presentation of Injury:

·         General tenderness over the lateral femoral condyle;

·         Sharp, burning pain when pressure is applied to the lateral epicondyle during flexion and extension;

·         Pain usually intensifies following intense exercise and is not always apparent throughout the exercise program;

·         Pain is exacerbated by going DOWN stairs & walking/running DOWN hill;

·         ?visible redness and/or swelling.

What should you do initially?

·         Rest;

·         Ice;

·         Stretch ITB & Gluteals.

What should be avoided?

·         Aggravating factors;

·         Impact/repetitive sports, ie. running, cycling;

·         Ignoring the problem.

If symptoms persist following rest, ice and stretching, one should see a physiotherapist for diagnosis and treatment. This is important as if the pain persists, permanent biomechanical damage may occur.

At Function360 we aim at identifying the underlying causes of the pain, targeting them through specialised treatment and specific/functional rehabilitation.

Author Jordane Zammit Tabona

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