Sports Therapy

Iliotibial Band Syndrome

On August 4, 2011
By Dr. Nekessa Remy | 0 Comments

The Iliotibial band is a muscle which functions to stabilize the knee and hip during flexion of the knee. ITB Syndrome (ITBS) is an overuse injury well recognized as a common cause of knee pain. ITBS is marked by sharp, burning knee pain and may be associated with swelling around the knee. The pain itself is usually felt along the outside of the knee.  ITBS is particularly common in runners and cyclists. Research has reported that ITBS makes up almost 12% of all running-related injuries.

Other Common Symptoms:

  • Start running pain free, but develop symptoms after a reproducible time or distance
  • Initially, symptoms subside shortly after a run, but return with the next run
  • Running downhill and /or with a lengthened stride cause pain

What Is the Iliotibial Band ?

The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor Fascia Latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). It also has attachments to the gluteus maximus muscle.



Beneath the lower part ITB is a region of adipose (fatty) tissue. This fat pad is located underneath the ITB between the bone of the knee (lateral epicondyle) and the ITB itself. This fatty tissue has a great deal of nerves and arteries surrounding it which makes it very sensitive to pain and pressure.

When we bend or flex the knee the ITB is pulled medially or towards the knee. This compresses the fat pad, which is located just underneath the ITB, into the bone of the knee. Continuous flexion/tension will irritate the fat pad and cause pain and possibly swelling at the knee.


  Common Cause of ITBS

  • Downhill running
  • Increasing mileage too quickly
  • Poor running or cycling mechanics/technique
  • Poor footwear
  • Anatomical mechanical deficiencies:
    • increased pronation
    • gluteal muscles weakness/inhibition


Role of Gluteal Muscles

According to research, weak hip abductors (lateral gluteal muscles), during eccentric contraction of support phase of running phase, appear to be responsible for ITBS. The muscle most involved is the glute medius. Its job is to steady the pelvis during gait.

Glute medius weakness will trigger compensation by weaker hip abductors including the glute minimus and Tensor Fascia Latae.  Since the ITB is attached to the tensor fascia latae, an increase in tensor fascia latae stress will cause increased tension on the ITB. All together this creates greater compression of the fat pad located underneath the distal ITB and ultimately causes symptoms of ITBS.

Prevention of ITBS= Strengthen the Glute Medius

The gluteus medius is a thick fan-shaped muscle and its posterior part is covered by the gluteus maximus. It originates from the outer surface of ilium. The fibers pass then downward and laterally to get inserted to lateral surface of the greater trochanter (outer hip).

As mentioned previously this muscle is a hip abductor, meaning in lifts the leg away from the body. It also plays a role in internal rotation of the hip. Its most important job is to stabilize the pelvis during gait. For instance, it prevents the pelvis from rotating downwards or sagging when the opposing side is lifted or not supported with the other leg during walking/running.

Glute Medius Exercises

1. Side Leg Lifts

Lie on one side, tighten the thigh muscle of your top leg, and then slowly raise the leg off the floor (at least 30 cm from the ground). Hold the leg up for a 2 count, and lower it on a 4 count. Relax your muscles. Then tighten the thigh and repeat.



2. Hip Hike

Standing on an elevated surface with the weight on one leg, hip sticking out, straighten the weight-bearing leg until it is even with or even hiked up above the elevated leg. Repeat 10-15 times per leg.


 3. Monster Walk

Put your feet inside of the tube and place it right below the bottom of your calf muscle OR hold the band in each hand, step on the middle of it with both feet, and now cross the band by switching the handles and putting them into the other hand.

Start with your feet together and then take a step directly to the side with one foot, slowly. Take a step with the opposite foot in the same direction. Continue slowly one foot at a time.



4. Wallbangers

Stand with your right side about 6 to 12 inches from a wall. Squat and lean your upper body to the left until your right hip touches the wall. Do not pause at the wall, you should recoil off and return to center.


It is important to note that if you are experiencing knee pain, you should consult with your chiropractor prior to starting any of the above exercises.

For more information on the treatment and prevention of Iliotibial Band Syndrome, please contact Mississauga Chiropractor, Dr. Nekessa Remy at 905-820-7746  or to book your complimentary consultation please email

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