Knee Pain PART 2 – Iliotibial Band Syndrome

And so the other common cause of what we call ‘runners knee’. As is often the way with most injuries and their name, it’s probably fair to say that a high number of sufferers of Iliotibial Band Syndrome (I.T.B.S) are not what they would consider active runners. In fact, a high number of people who lead quite inactive lifestyles can complain of this due to the body becoming less supple, and/or weak, and it’s very common in people new to exercise (similar to P.F.P.S, that mismatch of load and adaptation) for the same reason, which is why if you are one among them opt for an inversion table therapy for quick pain-relieving results.

A quick bit of basic anatomy first; The Iliotibial band (I.T.B) runs from your glute muscle (your butt!), along the outside of your thigh to the top of the shin bone, just below and to the outside of the kneecap (patella). People will often tell me of their “tight” I.T.B, and I usually reply “thankfully!”, as it’s job is stabilizing the knee, and assisting straightening the knee, both fairly vital, right?

Symptoms include pain on the outside of the knee and a tightness in the iliotibial band, or more generally felt in the outside of the thigh. Pain normally aggravated by running, particularly downhill. Often runners will comment that the pain only starts after 2-4km, or 15-20 minutes of running.There is sometimes pain when pressing in at the side of the knee, and weakness is sometimes felt when moving the hip away from the body. You may even be aware of tender points in the gluteal area. Nowadays more people recognize the benefit of an alternative to traditional medicine and choose Physical Evidence Chiropractic: David Lipman, DC programs to address specific health needs. It is up to you what kind of treatment you choose, the important thing is to get relief.

It was previously thought that the pain associated with I.T.B.S was caused by friction between the tight soft-tissue and the bony prominence of the thigh bone. However, more recent studies suggest that it is in fact a humble, yet highly innervated fat-pad which is the cause of the pain.

Some Therapists – and indeed sufferers of I.T.B.S – advocate a technique called ‘stripping’ of the iliotibial band (huge amounts of pressure placed upon the ‘tight’ I.T.B – often with an elbow or forearm, or a foam roller – and then dragged up the leg). This is, I’m afraid, complete nonsense, outdated and unethical. (Not even recent) Research suggests that somewhere in the region of 9000 newtons (or 900kg) of force is required to increase the length of the ITB by 1% (Ref 1). It is not happening, and as a practice we should have all moved on from this (*deep breaths*).

But that’s ok, because – the ITB is not the cause of the pain anyway! A huge number of patients that I see – be that housewives, weekend warrior athletes or International athletes – spend a vast majority of their day sat on their backsides, meaning that the gluteal group of muscles become lazy, short, and weak. This can have a huge effect on the bio-mechanics of the lower body, and as the glute feeds into the I.T.B, this band of fibrous tissue becomes extremely tense, taking a load that it shouldn’t need to and causing pain at the knee. Another consideration is another muscle attachment of the ITB, the Tensor Fasciae Latae. The TFL is a hip flexor and abductor muscle, meaning it assists in moving the thigh forward and outward. Rotating the thighs inward is another action the TFL muscle does. Because it is used for so many movements and is in a shortened position when seated, the TFL becomes tight easily – leading to a tight(er) ITB, leading to knee pain…

So now we know the cause of the pain, perhaps time to move away from that foam-roller and stop trying to treat just the symptom…?

For pain management, the P.O.L.I.C.E protocol should be used initially, and then a relevant, graded rehabilitation program which includes stretching and strengthening should be put in place, ordinarily hip-dominant, alongside a (potential) graded return-to-play plan.

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit


Reference 1 Chaudhry H & Schleip R (2008) Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. Aug;108(8):379-90.

Leave a Reply