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What Runners Need To Know About ITB Syndrome

Dena Barsoum, MD, physiatrist at HSS.
Dena Barsoum, MD, physiatrist at HSS. Photo Credit: HSS

The iliotibial band (ITB) is a dense fascia extension of the gluteus maximus and tensor fascia lata muscles extending from the hip to the lateral (or outside aspect of the) knee. Additionally, it connects to the knee cap and quadriceps muscles.

ITB syndrome is classically thought of as pain resulting from overuse and friction of the ITB against the lateral femoral condyle at the knee. Repetitive knee flexion and extension (like in running) can lead to this friction syndrome. Besides tightness of the ITB, relative weakness of the hip and gluteal muscles are important risk factors for ITB syndrome. Symptoms of ITB syndrome are usually sharp or burning pain at the lateral knee, especially with repetitive activities. Runners may notice a specific time when symptoms start, for instance, “It always hurts after I’ve been running for 15 minutes,” and symptoms may worsen with downhill running. Interestingly, running faster may cause less knee pain as knee flexion angles will vary.

Your doctor can diagnose ITB syndrome based on your physical exam. Treatment for ITB syndrome includes relative rest and initial avoidance of aggravating activities. This can be done by cross-training and/or continuing to run but only at distances or times that do not produce pain. Ice and nonsteroidal anti-inflammatory medications can be helpful to reduce pain and inflammation. If symptoms are severe, your doctor may perform an ultrasound guided injection of an anti-inflammatory steroid medication near the attachment of the ITB to your knee. Together with your doctor, a physical therapist can help identify the underlying biomechanical factors contributing to developing ITB syndrome. With the right treatment and rehabilitation as well as modifications to your exercise program, runners with ITB syndrome can continue running with less pain.