ITB Friction Syndrome (Runner’s Knee)

Introduction
The iliotibial band (ITB) is a thick band of connective tissue that runs along the outer side of the thigh and attaches to the knee. There is a layer of fat and connective tissue between the ITB and the end of the thigh bone.

Repetitive motion of the knee (such as when cycling or running) can place compressive loads on the ITB, irritating the band and/or the tissue beneath it. This results in a type of knee pain called ITB friction syndrome.

The compressive loading of the ITB can occur for several reasons, such as: muscular weakness, muscular tightness, excessive load (e.g. overtraining) and technique issues (e.g. when running, especially if fatigued).

What Are the Signs and Symptoms?

Signs and symptoms vary but mainly include:

  • Pain on the outer side of the knee, possibly radiating to the outer thigh or calf
  • Pain often described as ‘sharp’ or ‘burning’
  • Gradual onset of pain
  • Muscular fatigue (e.g. pain initially came on after intense exercise)
  • Pain with repetitive knee bending/straightening (e.g. running, cycling)

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Physical examination

A physiotherapist can diagnose ITB friction syndrome without the need for diagnostic imaging, such as MRI. Common findings include:

  • Tenderness on the outer side of the knee
  • ITB tightness or irritability
  • Muscular tightness (e.g. hip muscles)
  • Muscular weakness (e.g. thigh muscles)
  • Problems with various movements such as running, squatting, hopping, etc.

Treatment

Acute management may be required to reduce pain and inflammation, which can include:

  • Rest
  • Ice
  • Gentle soft-tissue massage
  • Potential referral for medical treatment, such as oral anti-inflammatories or corticosteroid injection (rarely required!)

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Once the injury has settled down, further treatment can commence, including:

  • Deep tissue massage
  • Dry needling
  • Stretches
  • Foam rolling
  • Strengthening exercises
  • Coordination / balance exercises
  • Technique correction (e.g. running technique)
  • Gradual return to training and sport. You may initially have to stop running or cycling, but other options may be suitable, such as swimming.
  • Footwear modification may also be appropriate

Written by Body Rhythm Physiotherapist Sean O’Brien.

References

Brukner, P., & Khan, K. (2011). Clinical sports medicine. (4th ed.). North Ryde, NSW: McGraw-Hill Education.

Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., … & Benjamin, M. (2007). Is iliotibial band syndrome really a friction syndrome?. Journal of Science and Medicine in Sport10(2), 74-76.

Lavine, R. (2010). Iliotibial band friction syndrome. Current reviews in musculoskeletal medicine3(1-4), 18-22.