Knees: The ITB epidemic
Author: By Doug James, intraining Physiotherapist, Podiatr
A common running knee injury will hear every year during the fun run season.
Each year (almost) without fail, winter sees a sharp spike in influenza cases. Around the same time of year, the running community experiences a substantial rise in ITB Syndrome injuries. The cooler months of the year herald the peak of the road running season in most Australian states and with that an increase in running training volume. Accompanying this is an inevitable increase in running injuries, with ITB (Ilio-Tibial Band) Syndrome often the most treated running injury at the intraining Running Injury Clinic. ITB Syndrome affects between 7-14% of runners at some point in their running career (1-5). Compared to other injuries this condition is more likely to prompt the affected runner to seek treatment due to the level of discomfort and inability to simply ‘run through’ the pain.
What is ITB Syndrome?
The ITB (Illio-Tibial Band) is a long tendon-like band that runs from your hip, extends around the outside of your knee and attaches to the front of the top of your lateral shin. It has a role in stabilising the knee and is spoken about with hushed tones in running communities. It is frequently demonised, this fear is often misplaced. True, the ITB has a role in ITB Syndrome but not in the way it was traditionally thought – hence why traditional treatment approaches frequently fail .
Isn’t it called ITB Friction Syndrome?
For years ITB Syndrome was referred to as ITB ‘Friction’ Syndrome[2,5] based on the idea that the ITB was causing rubbing on the side of the knee. Given that the ITB is well anchored around the knee, it is unlikely that it has sufficient freedom of movement to actually achieve this. IT Bands are often diagnosed as being ‘tight’ however there is a lack of contractile tissue in it for the actual band to
become tight or otherwise, though conjecture exists as to whether stretching can be an effective means of managing the injury, with some cadaver studies showed that it can be achieved, this may not be applicable in real-world situations.
I’m worried the pain is because my knees have worn out from running!
It needs to be noted firstly growing body of evidence where science supports that running doesn’t cause arthritis or ‘worn out’ knees. Secondly, ITB Syndrome is not a true knee injury. While the injury pain is felt near the outside of the knee – and often feels worse with knee movement – there is not usually any damage to the actual knee joint. Instead, the pain comes from irritated soft tissue and nerve ending near the femur (thigh bone) external to the knee, and reducing this pain is the initial goal of treatment. From there, identifying and correcting the causative factors is important.
Am I at risk?
A number of anatomical factors have been identified to contribute to the development of ITB Syndrome. These include having a wide pelvis with steeper angles in neck of femur (hip joint insertion) and femoral shaft (thigh bone)  and a narrow base of gait – all factors more commonly seen in female runners. While these anatomical factors will have always existed in a runner, it is usually when activity-related factors come into play that ITB Syndrome injury develops.
One of the more common activity-related factors linked with ITB Syndrome – and in fact most running injuries – is training errors. Increasing the volume and intensity of running too much over too short of a time period is a large risk. Additionally, doing too much downhill running also heightens your chances of ITB Syndrome developing.
I tried resting, but I still can’t run without pain!
ITB Syndrome is frustrating, and simply not running for several weeks or even months is not the answer. You may no longer feel pain when walking or running short distances, but the pain is likely to return again within a few kilometres of running. Some injuries you can run with and they will warm up and settle. This is not one of them.
Should I stretch or strengthen?
Why not both? Instead of resting, rehabilitating ITB Syndrome requires an active approach whereby any muscle imbalances need to be identified and rectified [2,5,6]. Your running specialist will be able to identify the key areas that need work and prescribe for you appropriate exercises. Running technique can play a part in the development of the injury. Overstriding (landing on an outstretched leg too far in front of your hips) seems to have a role, as does running with too slow of a cadence (foot strike rate).
Tip 1: Have our injury checked
It’s important to have your injury thoroughly assessed to correctly identify the injury and understand why it developed so as to help you avoid it happening again.
So, can I just pick up running where I left off?
Returning to running after having ITB Syndrome requires a measured approach. This requires a conservative re-introduction in terms of initial running distance and frequency with increases in either done cautiously. It is also suggested that downhill running should be minimised at this time, and attention given to running technique. For those returning to running, a plan devised by a running specialist is recommended.
Tip 2: Return to running with a program
A carefully curated running training plan is an important part of a successful recovery from – and avoidance of – ITB Syndrome.
If you’ve had a prior history of ITB Syndrome or looking to take a proactive approach to injury prevention – some injuries may be avoided by following a custom running plan designed with your running goals and injury risk profile in mind.
If you have been suffering pain from running, or are returning to running after having ITB syndrome or other injuries, it’s worth contacting the intraining running injury clinic to book an appointment with a physiotherapist or podiatrist.
We are all runners, with years of experience on the road and with managing runner’s injuries.
Book an appointment now! or Phone 07 3367 3088.
 Jelsing, E; Finnoff, J; Cheville, Andrea L; Levy, Bruce A; Smith, Jay, Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move? Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine, July 2013, Vol.32(7), pp.1199-1206
 Orchard, J. Is iliotibial band syndrome a friction syndrome?
Journal of Science and Medicine in Sport, 2007, Vol.10(2), pp.77-78
 Pegrum, J; Self A; Hall N; Iliotibial band syndrome. British Medical Journal (Online), Mar 21, 2019, Vol.364, pp. 1-6
 Wilhelm, M; et. al. Deformation response of the iliotibial band – tensor fascia lata complex to clinical-grad longitudinal tension loading in-vitro. International journal of sports physical therapy, February 2017, Vol.12(1), pp.16-24
 Falvey, E; et. al. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scandinavian Journal of Medicine and Science in Sports. August 2010, Vol 20. (4), pp580-587.
 Troilo, Lindsay; Davis, Irene. Successful Treatment Of The Underlying Cause Of ITB Syndrome. Medicine & Science in Sports & Exercise
Issue: Volume 48(5S) Supplement 1, May 2016, p 647.
 Estimate of recently treated running specific injuries by Doug James (Physiotherapist and Podiatrist) at the intraining running injury, Milton during June and July 2019.