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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).

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? In fact, I will happily publicly state I have never seen a floppy iliotibial band 🙂

Symptoms include pain on the outside of the knee and a perceived ‘tightness’ in the iliotibial band, or more generally felt in the outside of the thigh.

Pain is 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.

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. Glamorous, huh.

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 This is, I’m afraid, complete nonsense, outdated and unethical.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 long ago (*deep breaths*).

But that’s ok, because – the ITB is probably not the cause of the pain anyway!

There is commonly, again, a mismatch between load application, and load tolerance (how much you are doing vs. how much you can tolerate), and looking at this should be the foundation on which your recovery should be built. There are often relative muscle weaknesses which develop before, during or after ITBS, and this should also be assessed and addressed.

To conclude, ITBS is classic tale of spending more time finding the cause of the pain, and moving away from those short-term interventions that simply help a bit, for a bit.


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.

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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.

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