Iliotibial Band Syndrome


The pain that is experienced with Iliotibial Band Syndrome is located on the outer aspect of the knee. It is not a pain felt within the joint, as it does not affect the knee joint itself. If you flex the knee about 30 degrees, and apply pressure to the outside of the knee with your fingers, and if you experience pain, then you may have Iliotibial Band Syndrome. Another way to test for this condition is to walk stiff-legged (not bending the knee); if this produces no pain but walking normally (bending the knee) does produce pain, then you may have Iliotibial Band Syndrome.

What is Iliotibial Band (I.T.B.) Syndrome? The I.T.B. is a thickened strip of fascia or muscle cover. It begins as a thick band that covers the outer thigh muscles, and travels down the outside of the leg to the knee joint, where it attaches to the outer edge of both the tibia and fibula, just below the knee joint. In so doing, the I.T.B. must lie against the protruding outer edge of the femur, just above the knee joint. As the knee is flexed and extended, the I.T.B. rubs against a thin fluid filled sac (a bursa), between it and the femur. The bursa acts to reduce friction, and to protect the I.T.B. However, when the bursa does not function properly, or there is a change in your running or cycling pattern, or a biomechanical foot or leg problem begins acting up, the I.T.B. becomes inflamed and painful.

Biomechanics: As an athlete runs or pedals a bicycle, flexion and extension take place at the knee. When the knee is flexed 30 degrees or more, the I.T.B. passes over the outer protruding edge of the femur, shifting posterior behind the edge of the femur. As the knee is extended, the I.T.B. passes back over the edge of the femur, and shifts anteriorly in front of the femur. It is this motion that commonly leads to irritation and pain of the I.T.B. and its protective bursa. If a biomechanical defect is present, such as bowlegs or pronation in the feet, the I.T.B. rubs against the edge of the femur with more force, causing greater irritation and pain.


Causes of Iliotibial Band Syndrome: Although the onset of this condition has been linked to athletic maltraining, such as an increase in running or cycling distances or running on a pitched surface, research has shown that in most cases of I.T.B. Syndrome, a foot or leg biomechanical abnormality is also present. The most common of these abnormalities found in athletes suffering from this condition is:

  1. Pronation of the foot is the number one abnormality linked to I.T.B. Syndrome. Pronation causes the tibia to rotate internally and tightens the I.T.B., causing it to rub with more force against the edge of the femur. This eventually produces inflammation and pain. Click here for more information about pronation.
  2. High or low arches prevent the arches in the feet from acting as the natural “shock absorbers” they were designed to be. Thus, the force of each foot strike (up to 3 times the body’s weight) is passed on to the knee area. When this occurs the soft tissue structures surrounding the knee tighten, causing the I.T.B. to rub with more force against the edge of the femur, eventually producing pain.
  3. Short leg syndrome causes the foot on the short leg to excessively plantar flex (the foot and toes are pointed down) in order to “reach” the ground. This pulls on the muscles and soft tissues in the outer aspect of the leg, causing the I.T.B. to tighten against the femur. When this occurs there is excessive rubbing, friction, and pain. Click for more information about Short Leg Syndrome.
  4. Bow-legs also cause tightening of the soft tissues on the outer aspect of the leg and knee, forcing the I.T.B. to rub with greater force against the edge of the femur. This will eventually produce inflammation and pain.

Treatment, Self-Help, and Exercises

Short-Term Pain Relievers: These steps will help to provide you with short-term pain relief.

  1. Reduction of weekly training sessions by at least one half. During these sessions, also reduce your mileage by one half.
  2. Shorten your stride.
  3. Running and cycling must be done on flat surfaces; avoid pitched and circular tracks.
  4. Frequent applications of ice packs to the outer aspect of the knee. (Chemical ice packs or bags of frozen peas, held loosely in place with an Ace Bandage work well.) If the cold becomes uncomfortable, remove the ice pack immediately.
  5. Stretch the I.T.B. by doing side-stretching exercises. While standing and holding on to a chair, place the injured leg behind the pain-free leg (e.g., if the right leg is painful, place it behind the left leg). With both feet planted firmly on the ground, lean away from your right side, toward your left side (do not rotate your body; just lean). You may, or may not, feel a pull on the I.T.B.; either way is okay, so be careful not to over-stretch. Hold this position for 10 seconds. Rest and repeat this exercise 10 times. If the pain increases, stop immediately.
  6. Protect the I.T.B with our extremely effective I.T.B. Strap. It applies compression at the area of discomfort to help relieve Iliotibial Band Syndrome. This I.T.B. Strap is recognized as one of the most effective treatments for Iliotibial Band Syndrome.

Long-Term Pain Reliever: The following remedy will:

  1. Help provide long-term pain relief.
  2. Significantly reduce recurrences of this disorder.

In order to obtain long-term relief from I.T.B. Syndrome, you must control the biomechanical abnormalities of the legs and feet that cause the I.T.B. to rub against the outer aspect of the femur with excessive force. Unless these problems are quickly and properly overcome, the I.T.B. pain may not completely subside; or if it does, it will usually return when normal running and cycling begin again. To treat these abnormalities, you must stabilize the feet; provide proper shock absorption in the foot, so that abnormal forces are absorbed in the foot, and not passed on to the knee; and, control limb shortages and bow legs. The best way to effectively treat these problems, and help to eliminate I.T.B. Syndrome, is with the use of custom-made sports orthotics designed for this condition.

Custom-Made Orthotics for Iliotibial Band Syndrome: The advanced technology we employ enables our sports orthotics to gently hold the feet in their neutral or normal position, thus overcoming the biomechanical defects of the feet and legs (such as pronation and bow legs) that lead to I.T.B. Syndrome. This allows the feet to function as the efficient and stable foundation that our body needs; and when the Iliotibial Band, knee, hip, and back are not subjected to abnormal stresses, they function in their proper alignment. This reduces fatigue and pain throughout the entire body, not only the knee.

Our orthotics will also provide semi-flexible support to the arch by “giving” to absorb the shock of each step, rather than our foot and knee (the orthotic acts in the same way that a shock absorber does on an automobile). When our weight is removed from the orthotic, the arch returns to its original height since the material we use has a built-in “memory.”

Shortages in one leg are easily addressed by adding the proper lift to the orthotic for the short leg (click here for more information about Short Leg Syndrome).

And by providing increased padding and support for the balls of the feet using materials that mimic the action of our own fatty pads, our sports orthotics will not only provide comfort, but will also help to prevent stress fractures, joint pain, and callus pain.

Click here for more information about our custom-made sports orthotics.