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Home -- running -- INJURY ARTICLES -- Ilio-Tibial Band Syndrome (ITBS)
Ilio-Tibial Band Syndrome (ITBS)Ilio-Tibial Band Syndrome (ITBS)
Author: Dennis N. Kiper, D.P.M Source:

Lateral knee pain in runners is often caused by Iliotibial Band Syndrome (ITBS). The Ilio Tibial Band is a thick broad tissue which runs from the outside of the pelvis (over the hip) down the thigh and inserts just below the knee (on the outside).  The symptoms range from a stinging sensation on the outside of the knee (most common), or along the entire length of the Ilio Tibial Band, to swelling. The pain will worsen with activity when the foot strikes the ground and overpronates (where the foot "spreads" to the floor), especially if you overstride or run downhill and may persist afterward. A single workout of excessive distance or increase in mileage can aggravate the condition.

This condition is one of the worst injuries to have because of the slow healing properties of tendon tissue. In addition, not decreasing training or activity contributes to the slow healing process.

Resolution can easily take 6 months?1.5 years.


  Other causes of the injury are:

   1-The key element and most single common entity is overpronation in one foot greater than the other. Typically the patient has a "functional shortage" on one side, where one leg is pulled higher into the hip joint (acetabulum) as a result of rotation of one of the hip bones (ileum)which began early in life.

   2-Running on a banked surface, which causes the downhill leg to bend slightly more inward and cause extreme stretching of the band.

   3-Inadequate warm up or cool down

   4-Running excessive distances or increasing mileage too quickly

   5-Anatomical abnormalities i.e limb length discrepancies, bowlegs and tightness  about the ITB

Treating Ilio Tibial Band Syndrome should consist of the following:

  1. Decrease mileage
  2. Ice knee after activity [do not apply ice directly]
  3. Alternate running direction on banked surface
  4. Stretching the ITB [Be careful to stretch to tension and not overstretch I recommend stretching 2x/day]
  5. Any support to help minimize overpronation.
It must be understood that even with the best of control one can still be vulnerable due to overtraining. The difference is that with biomechanical  control the likelihood of reinjury is lessened.

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