ITB friction syndrome

Well…. it is that time of the year again where a few unfortunate runners come in to see me every week with the dreaded runners curse… ITB friction syndrome.

I want to dedicate this blog to ITB friction syndrome.

The blog will aim to highlight some anatomical links, causes or pre-disposing factors and of course treatment of the condition.


ITB friction syndrome accounts for roughly 12% of running injuries (Fairclough et al, 2006).  It is described as an aching on the lower and outside of the knee.  It is more common in runners>triathletes>cyclists.  Training errors can account for a large component of the problem, with higher weekly km’s and a sudden increase in track running being linked to the condition.

Anatomical considerations

The ITB is generally viewed as a band of dense fibrous connective tissue that passes over a bony prominence of the femur called the lateral epicondyle, which then extends down to attach to the outer portion of the upper tibia or shin bone.  Patients with ITB friction syndrome will generally present with tenderness over this bony prominence and report a sharp, burning pain in that location during running, especially during the swing phase and downhills.

Around the ITB is a complex network of anatomical structures that influence the development of ITB friction syndrome.  Primarily the gluteus maximus (your butt muscle) inserts into the ITB, as does the Tensor Fascia Lata (TFL), which is found on the front of your hip.  Recent studies have also indicated that the outer quadriceps and hamstrings have anatomical connections.  Tightness or over activity in these muscles can hence influence the interaction of the ITB on the outer knee and alter the force distribution around the knee with running.

Causes or pre-disposing factors

There certainly is some research of various levels to link some of the following with ITB friction syndrome.

  • Camber runs (very common to get ITB friction syndrome post a marathon due to the camber on a road run… so run in the middle of the road if possible!)
  • Changed bike set up
  • Poor footwear
  • Hill running, especially downhills
  • Leg length discrepency
  • Excessive pronation or rear foot control
  • Pelvic asymmetries
  • Poor core control
  • Weak gluteal muscles (Glute max and med especially) and poor motor control
  • Training errors (Too hard to fast, increasing the weekly km’s too quickly)


Each individual will have their own specific links into the condition.  However being an overuse injury, commonly there is a mixture of intrinsic (within your body) and extrinsic (external) links to the problem.  That is it is multi-factorial in origin.  So the aim is to identify the main contributing factors.

Common links are mentioned above and typically treatment focuses on a combination of symptom relief mixed in with a thorough assessment of your specific contributing factors.  For example if you have ITB friction syndrome and a race is coming up you may need to consider an ultrasound guided cortisone injection or more recently extracorporal shockwave therapy (ESWT) has been used.  This is due to the recent understanding that the ITB is firmly attached to the lateral epicondyle and may be more of an enthesospathy (tendon attachment pathology) rather then a friction syndrome… but that is another story!  More basic options involve using voltaren gel (a good dollop) and wrap it up in glad wrap overnight, icing and anti-inflammatory medication.

Outside this it is critical to get to the bottom of why this happened in your specific case.  That is if there are obvious training errors, you need to learn from that, settle the symptoms then reload the running once it is pain free.  However commonly there are intrinsic links that must be addressed.  So…. if you have a weak glute, poor core, tight hamstring just to name a few… then they must be addressed.  Commonly a thorough instruction on the use of a foam roller is essential to prove release to the trigger points in the TFL, Glutes and outer quad.   Changing the biomechanical load through the ITB area while your symptoms are settling with remedies mentioned above will minimise the risk of re-occurence with the resumption of running.

So I hope this gets the mind thinking a little bit more about injury prevention, with a specific focus… however the general principles are similar to what I have mentioned in previous blog posts.

If you have any questions, feel free to ask me!



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