Understanding Iliotibial Band Syndrome (ITBS):Causes, Myths, and Rehabilitation

Written by: Brian Bannon, Senior Physiotherapist @ Uplift Physio

If you’re a runner, cyclist, or someone who enjoys repetitive lower limb activity,

you’ve probably heard of Iliotibial Band Syndrome (ITBS) — one of the most

common causes of pain on the outer side of the knee. With major running events

around the corner, understanding ITBS can help you prevent, manage, and recover

effectively.

What Is Iliotibial Band Syndrome?

The iliotibial band (ITB) is a thick strip of connective tissue running from your hip

down to just below your knee. It plays a key role in stabilizing the knee and hip

during movement.

ITBS occurs when repetitive motion causes compression of the fat pad between

the IT band and the femur, leading to irritation and inflammation. Contrary to popular

belief, ITBS isn’t a “friction” problem—it’s more of a pressure or impingement issue

caused by repetitive stress.

The IT Band’s Function

The IT band acts as a tension cable, keeping your knee steady during walking,

running, and cycling. It doesn’t contract or stretch like a muscle, but it works in

harmony with your hip muscles to control movement and absorb forces through your

leg.

When hip muscles become weak or fatigued, the ITB absorbs extra load, which

increases strain and leads to inflammation—especially during early stages of running

when the knee bends between 0–30 degrees.

Common Myths about ITB Syndrome

❌ Myth 1: “You just need to stretch the IT band.”

➡ The ITB itself can’t really be stretched. Relief comes from strengthening

surrounding muscles and improving biomechanics, not from trying to elongate the

band.

❌ Myth 2: “Foam rolling breaks up tight tissue.”

➡ Foam rolling doesn’t change ITB length or structure—it simply stimulates nerve

endings and may temporarily reduce tension or pain.

❌ Myth 3: “Deep tissue massage fixes the IT band.”

➡ In fact, aggressive massage can worsen inflammation. Focus instead on gentle

mobility and functional strengthening.

Why Doesn’t Every Runner Get ITB Syndrome then?

Not every runner develops ITBS because individual biomechanics differ. Research

shows that hip muscle weakness, especially in the abductors, can lead to

excessive knee movement and strain on the IT band. When the hip muscles fatigue,

the body loses its ability to absorb impact effectively, transferring stress to the

knee.

Biomechanical Assessment

A good rehab plan starts with understanding how you move. Key aspects to evaluate

include:

-Hip and pelvic stability.

-Knee tracking during landing and stance.

-Foot and ankle alignment.

-Gait patterns and cadence.

Identifying flaws allows you to adjust running form and strengthen the right

muscles.

Evidence-Based Rehabilitation

Management focuses on load modification, neuromuscular retraining, and

progressive strengthening.

In the acute phase, reducing aggravating activities and introducing isometric hip

abduction exercises helps maintain muscle activation while minimizing joint stress.

As symptoms subside, rehabilitation progresses toward closed-chain exercises such

as single-leg squats and step-downs, emphasizing control through 0–30° of knee

flexion.

The final phase incorporates sport-specific drills, plyometrics, and controlled return to

running with gradual load progression. Addressing underlying biomechanical and

neuromuscular deficits is critical to prevent recurrence.

Adjunctive Interventions

Manual therapy and myofascial release may be used to alleviate discomfort, though

these should complement — not replace — targeted strengthening and gait

correction. In persistent or recurrent cases, imaging studies may be warranted to

exclude alternative diagnoses such as lateral meniscal pathology.

Key Takeaways

-ITBS is a compression-based pathology, not a friction or tightness problem.

-Hip and pelvic stability play a central role in both prevention and

rehabilitation.

-Treatment should emphasize neuromuscular control, strength restoration,

and load management, rather than passive modalities.

-A phased, individualized rehabilitation approach supports tissue adaptation

and safe return to sport.