ITB Syndrome Explained: What Causes It and How to Treat It Safely

Iliotibial band (ITB) syndrome is one of the most common causes of lateral knee pain. It is commonly thought to be caused by friction of the ITB on sensitive underlying structures causing knee pain. However, more recent research suggests its pathology is more likely due to compression due to excessive hip adduction & internal rotation during weightbearing.

The ITB itself is not a structure which can be stretched which is why addressing contributing factors such as hip strength & control should be considered in its management.

What Is ITB Syndrome?

ITB syndrome occurs when the iliotibial band — a thick band of connective tissue running along the outside of the thigh — irritates structures at the knee or hip during repetitive activity, causing pain on the lateral side of the knee.

Key Causes of ITB Syndrome

ITB syndrome is often caused by hip weakness, poor biomechanics, overuse, and repetitive activity such as running or cycling. Excessive hip adduction and internal rotation during weightbearing can compress the ITB against underlying structures.

How to Manage & Treat ITB Syndrome

Giesler (2020) suggests a three-stage program to address hip strength & control – a contributing factor to ITB syndrome:

1. Low load – open chained exercises (side lying abductions & prone mule kicks) & hip extension exercises (single leg glute bridges)

2. Moderate load – closed chain exercises (single leg mini squats, lunges & single leg mini squats)

3. Higher load – deep single leg squats, drop jumps & resisted crab walks

This program is not a recipe for all knee pain however it could be considered if you have been diagnosed with ITB syndrome.

The exercises discussed below can also help shape your rehabilitation if you are suffering from ITB syndrome, as they specifically discuss the role of our hip musculature.

Prevention Tips to Avoid ITB Syndrome

• Ensure proper hip strength and control before increasing running or cycling intensity.

• Gradually increase training volume and intensity to reduce overuse stress.

• Monitor running or cycling form to minimise excessive hip adduction and internal rotation.

Whether you need a sports physiotherapist for an injury or you want to feel better, trust the experts at Body Fit Physiotherapy.

More About the Glutes

The gluteus medius is a vital muscle in everyday activity. Its main role is to help stabilise the pelvis and prevent the opposite side from dropping while walking, running and single leg weight-bearing (e.g., climbing stairs). Although the functionality of these exercises may seem questionable, they are very effective at glut med activation and may benefit you at some point along your rehab journey.

A study conducted by Boren et al. (2011) explored the EMG activity of the gluteal musculature during 18 common strengthening exercises.

They determined that by knowing the % maximal voluntary muscle contraction of the gluts during these exercises would therefore correlate to potential gains in muscle strength.

The top 5 Gluteus Medius exercises:

1. Side plank abduction (dominant leg on bottom)

2. Side plank abduction (dominant leg on top)

3. Single leg squat

4. Clamshell (progression 4)

5. Front plank with hip extension

Video – Demonstration of Gluteus Medius Exercises

REF

Iliotibial band pathology: synthesizing the available evidence for clinical progress – Geisler P (2020)

Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises – Boren et al. (2011)