The iliotibial (IT) band is a superficial thickening of tissue that runs from the outside of the pelvis (ilium) above the hip bone and extends along the outside of the thigh and inserts below the knee joint to the upper shin (tibia) bone. Iliotibial band friction syndrome (ITFS) occurs when there is constant rubbing and friction of the IT band at the outside of the knee during 30 degrees of flexion.

Contributing factors

• Leg length discrepancies
• Hard surfaces
• Uneven surfaces (downhill side on cambered road)
• Downhill running
• Over pronation
• Under pronation (bowed legs)
• Pelvic weakness (gluteus medius in 70%)
• Training error (peak training season, high mileage, slower pace)

Symptoms

Severe localized pain and tenderness is felt outside the knee joint only during exercise and is absent at rest. Running downhill aggravates the pain. The pain subsides when running is stopped but will return rapidly when running is continued. Pain is worse going down stairs.

Treatment

• Ice
• Rest
• Reduce training
• Strengthen gluteus medius (92% success)
• Stretch ITB
• Orthotics (foot mechanics)
• Evaluate footwear
• Identify and address training errors (overuse, uneven roads)