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Your Guide to Iliotibial band (ITB) syndrome

This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.


Iliotibial band (ITB) syndrome is an overuse problem which causes pain on the outside of the knee just above the joint. It is often seen in cyclists, runners, and long-distance walkers. It can be due to overdoing an activity or training errors. It can also be due to muscle imbalances in the hip or other biomechanical factors in the lower leg.


The ITB is a long tendon that attaches to a short muscle at the top of the pelvis called the Tensor Fascia Latae (TFL) and runs down the side of the thigh, connecting to the outside edge of the shinbone just below the knee joint. The lower end of the ITB passes over the outer edge of the lateral femoral condyle (where the lower part of the thighbone bulges out above the knee joint). When the knee bends and straightens the tendon glides across the edge of the femoral condyle. A fluid-filled sac called a bursa rests between the femoral condyle and the ITB. A bursa acts as a cushion for soft tissues from friction, such as where muscles or tendons glide against one another. With repeated knee movements the bursa between the lateral femoral condyle and the ITB can become irritated and inflamed by the ITB snapping over the condyle.


Pain over the outside of the knee, just above the knee joint is the most common complaint. This area may also be sore to touch, particularly after activity. Pain may radiate up the side of the thigh and down the side of the leg.

What Happens If I Don`t Fix My Knee?

It is important to address the underlying cause of your condition to prevent future recurrences. If it is due to overuse your physio will look at your training schedule, footwear and types of terrain used during training to see if these factors may be contributing. If there is a muscle imbalance problem where some muscles are weak and/or tight and you do not address this, then you may find your symptoms may worsen or reoccur with continued activity.

How Long Does It Take To Get Fully Better?

The length of time will depend on each individual’s condition and the degree of inflammation and muscle imbalance that may exist. Your symptoms often settle within a week or two of stopping aggravating exercise like running, however it then usually takes a few weeks to gradually progress back into your normal exercise routine. Generally stretching and strengthening gains are made over a 4-8 week period. Starting treatment early often significantly improves recovery times.

Your journey to peak performance with Central Physio

Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.

Phase 1: Optimise and Control Inflammation

Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Therefore, the first goal is to reduce the inflammation and pain in your ITB.

The techniques your physio may use to manage your inflammation include specific local massage and muscle releases, ice and stretches. Importantly, they will also guide you on modifying your current activity and exercise to ensure that you are not continually reaggravating your inflammation as this will significantly slow your recovery.

Phase 2: Restore Muscle Length

When your ITB is tight it causes a lot more compression and stress as it crosses over the outer part of your thigh bone, just above your knee joint. Muscle tightness also puts extra stress on tendons where they attach to the bones, and can make the job of other muscles harder and cause too much load on joints. Tightness in your ITB can also cause compensatory movement changes in your leg, foot, hip, pelvis and spine. Therefore, it is important to get your full ITB length back to stop all this from happening.

Your physio will use techniques including specific muscle releases, stretches and heat for the muscles that attach to your ITB and other structures to regain your flexibility. If your normal exercise has been a significant cause of your ITB tightness then often an effective stretch routine will need to be included with your regular exercise on an ongoing basis.

Phase 3: Specific Muscle Strengthening

Weak muscles are a major problem when recovering from an injury. Often muscles are weak because they are not being used properly, they have been damaged, or they have been resting after an injury. When strengthening muscles you must strengthen the correct muscle and in the way the muscle would normally be used.

Often weakness in your gluteals (hip muscles) and core stabilisers are major reasons why your ITB has become overworked and tight. Your physio will guide you through a specific strength program to ensure you achieve a lasting recovery.

Phase 4: Proprioception Retraining and Functional Strengthening

Proprioception is your body knowing where it is in space. It is a key factor for playing sport and preventing injury because it provides fast reaction times and correct movement control during exercise. Often ITB syndrome is caused by poor awareness and control of your leg alignment during running, so restoring your proprioception is essential for an injury-free return to your normal sport and exercise.

Integrated with your proprioception retraining is functional strengthening. This phase makes sure that the right muscles are being used in the right combinations to keep your leg in the correct alignment during normal daily activities as well as during sport and exercise. Your physio may use wobbleboards, minitramps or discs to retrain your proprioception. Specifically graded exercises will also be used to combine propioceptive input with functional strengthening of your legs, hip/pelvis and core.

Phase 6: Sports/Ballistics and Advanced Strengthening

This is the last phase of your recovery plan and is essential for getting back to your previous level of performance and preventing re-injury. You need to be able to move at full speed and with full force in training first, before returning to your normal level of sport. Persisting background weakness or poor co-ordination will lead to inferior performance and increased risk of re-injury.

This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination and strength are restored.

Many clients find that seeing one of our Exercise PhysiologistsStrength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.

For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.