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Etiology and Treatment of Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) is a common overuse injury that affects many athletes and active individuals. It is characterized by pain and inflammation on the outer side of the knee, specifically at the insertion site of the iliotibial band into the knee joint. This blog post aims to delve into the etiology and treatment of ITBS, with a particular focus on exercises, soft tissue treatment, and precautions to take during recovery. The importance of proper footwear and ergonomics in promoting optimal healing will also be addressed.

Etiology of Iliotibial Band Syndrome:

ITBS typically arises from repeated friction between the iliotibial band (ITB) and the lateral femoral condyle during repetitive flexion and extension of the knee joint. This friction can result in irritation and inflammation of the ITB, leading to the characteristic pain and discomfort on the lateral aspect of the knee and less commonly the hip. Signs and symptoms include sharp pains of the knee and/or hip with the possibility of popping or a snapping sensations. The timeline of improvement of these pains is between four to six weeks when aggravating exercises and activities are modified. Several factors contribute to the development of ITBS, including:

1. Overuse: Engaging in activities that involve repetitive knee flexion and extension, such as running or cycling, without appropriate rest and recovery periods can increase the risk of developing ITBS. Introduction to new sport or recreational activity along with repetitive compressive force are all linked causal factors to this syndrome.

2. Muscular imbalances: Weak hip abductors and tight hip muscles, particularly the tensor fasciae latae and gluteus medius, can alter the biomechanics of the lower extremity and place excessive stress on the ITB.

3. Poor biomechanics: Abnormal foot pronation or supination, leg-length discrepancies, and faulty running or cycling techniques can disrupt the normal alignment of the lower extremity, increasing the risk of ITBS. Engaging in activities with correct mechanics and technique can reduce excessive stress on the ITB. Professional guidance and coaching may be beneficial in avoiding biomechanical imbalances. Excessive inward and outward translation of the knees in a squat or during long distance running should be avoided. A stronger focus on neutral knee bending straight forward is best.

Treatment of Iliotibial Band Syndrome

1. Exercises:

   a. Stretching and strengthening exercises: Stretching exercises for the hip muscles, ITB, and calves can also aid in improving flexibility and reducing tension. Strengthening the hip abductors, glutes, and quadriceps can help to balance muscular forces around the knee, alleviating stress on the ITB. When the pain is considerably decreased it is appropriate to add side lying clamshells, banded lateral side-walks, fire hydrants and weight-free squats/lunges (focusing on neutral knee mechanics).

   b. Core stabilization exercises: Strengthening the core muscles, including the abdominals and back muscles, can enhance stability and correct any biomechanical imbalances that may contribute to ITBS.

2. Soft tissue treatment:

   a. Foam rolling and lacrosse ball compression: Regular foam rolling of the hip flexors (Tensor Fasciae Latae), gluteals, hamstrings, quadriceps and calves can help to release tension, reduce inflammation, and desensitize the regions of complaint.

   b. Massage and Dry Needling therapy: Deep tissue massage, myofascial release techniques and active release techniques should be applied to the tissue stated above. Dry needling of the tensor fasciae latae and gluteals with use of an E-Stim unit is beneficial for reduction of trigger points and general muscle tension that is placed on the IT band. For retraining of the tissue it is very important to have a blank slate with relaxed and malleable tissue… Dry needling and other soft tissue therapies will expedite this goal.

3. Precautions to take during recovery:

   a. Reduction of high intensity exercise and modified activity: Adequate stretching and modification of activities that exacerbate symptoms are crucial for the healing process. With ITBS being a connective tissue disorder the body is telling the person that they have exceeded the capacity of what the target tissue can handle. Gradually increasing volume of mileage and lifting is crucial to allow the body time to adapt to the adjusted volume of activity. Gradual progression back to full activity should be followed to avoid re-injury.

   b. Ice and anti-inflammatory medications: Applying ice packs 15-20 minutes multiple times a day or using cryo chamber therapy for the affected area for can help reduce inflammation. Heat pack application along with careful warm-ups before rehab exercises is recommended.

Proper Footwear and Ergonomics for ITBS Recovery

During the recovery period, it is essential to consider proper footwear and ergonomics to optimize healing and prevent further injury. The following recommendations should be followed:

1. Footwear:

   It is essential to pay attention to one’s footwear and equipment. Wearing appropriate footwear that provides adequate support and cushioning is essential for preventing IT Band Syndrome. Ill-fitting or worn-out shoes can alter the alignment of the foot and lead to increased stress on the IT band.

   a. Pronation control: Pronation refers to the natural inward rolling motion of the foot during walking or running. Overpronation, where the foot rolls excessively inward, can lead to IT Band Syndrome. To prevent this, individuals with overpronation should wear shoes with adequate pronation control, such as motion control or stability shoes. These shoes have features like firm medial support and arch support to limit inward rolling and provide stability.

   b. Shock absorption: It is essential to choose footwear that offers ample shock absorption. Running and high-impact activities subject the lower limbs to considerable forces, leading to increased stress on the iliotibial band. Shoes with cushioning materials in the midsole, such as gel or foam, help absorb and distribute the impact forces, reducing the strain on the iliotibial band. Cushioned shoes are particularly beneficial for athletes with high arches or underpronation.

   c. Arch support: Proper arch support is crucial for maintaining proper foot alignment and biomechanics. Shoes with arch support help distribute the body weight evenly across the foot, reducing the strain on the iliotibial band. Over time, improper arch support can lead to overpronation or excessive strain on the iliotibial band. Look for footwear with built-in arch support or the option to add custom orthotics if necessary.

   d. Flexibility: Footwear should strike a balance between flexibility and stability. Shoes that are too stiff can alter the natural motion of the foot and increase stress on the iliotibial band. Shoes that are too flexible provide inadequate support and fail to absorb shock effectively. Finding a shoe with the right amount of flexibility allows for proper foot movement while maintaining stability and control.

   e. Proper fit: Finally, ensuring the correct fit of footwear is essential for preventing IT Band Syndrome. Shoes that are too tight or too loose can lead to improper foot movement and biomechanics, causing excess strain on the iliotibial band. It is recommended to have feet measured professionally to ascertain your correct shoe size and consider trying multiple brands and models to find the perfect fit for your foot shape and needs.

2. Ergonomics:

   a. Proper workstation setup: For individuals with ITBS who spend extended periods at a desk, ensuring proper ergonomics with an ergonomic chair, desk, and correct body positioning can minimize strain on the ITB.

Prevention of ITBS

To prevent this condition it is important to address the potential causes stated above.        Mechanics, hip and knee strength along with training volume is a focus that all athletes, recreational sports participants and consistent gym-goers should consider if previous occurrence of this syndrome has been experienced. Proper Warm-Up and Cool-Down: – Proper warm-up before engaging in any physical activity and cool-down afterward can significantly reduce the risk of injuries, including ITBS. Dynamic stretching exercises that target the hip and thigh muscles can help prepare them for the activity, while static stretching during the cool-down phase promotes muscle recovery and flexibility.


Iliotibial band syndrome is a common overuse injury that can significantly impact athletic performance and overall well-being. Understanding the etiology of ITBS and implementing appropriate treatment strategies, including exercises, soft tissue treatment, and precautions during recovery, is crucial for effective management. Additionally, emphasizing the importance of proper footwear and ergonomics can contribute to a successful rehabilitation process and reduce the likelihood of recurrence. By addressing these factors comprehensively, individuals with ITBS can recover and return to their active lifestyles.

Content provided by Dr. Parker Grundman

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