The ITB and Runners

The ITB and Runners:

Runners often experience pain in the Illiotibial band. They also often complain of hip or knee pain which can be linked to the ITB and even more commonly, complain of‘tight’ ITBs.


The Illiotibial Band is an extension of the tendon of Tensor Fascia Lata (TFL) It runs the length of the femur on the lateral side of the leg and inserts at the knee onto the lateral patella and onto a notch on the tibia.

Illiotibial Band Syndrome (ITBS) is one of the most common causes of knee pain in runners and is responsible for 12% of all running related pain (Taunton et al, 2002)

It is caused by excessive friction between the ITB and the lateral femoral epicondyle, which it must pass in order to attach at the knee.There is also a bursa present at this site, which sits between the femoral epicondyle and the ITB. This can also become inflamed due the extra friction caused by a tight ITB and so can cause further pain.

Conservative treatment of ITBS would involve ice to reduce any inflammation but would also involve lengthening of the ITB in order to reduce the friction present at the knee. Stretching, however of the ITB is often unsuccessful, as the ITB is not a muscle and therefore does not contain stretch receptors. This stops people being aware of when they are putting this structure on a stretch and so it can often be in effective. It is there for every important to bear this in mind and when stretching the ITB, focus on the anatomy of the structure and not on how it feels. Stretches could include:

One Leg Crossed behind the Other: This involves crossing one leg behind the other and continuing to face forwards. You can further this stretch by bending the knee of the supporting leg and sliding the stretched leg further from the body and holding onto to something for support. It is important to keep the hips and torso facing forwards though.

Foam Roller: Use a foam roller to roll directly over thelength of the IT band. Take your feet off the floor to increase the effect:

Resistance band stretch: Lying on your back use a resistance band to pull the leg into a hamstring stretch then slowly move the leg over the other one and turn the foot as inwards as possible against the band.

If you do suffer from ITB pain, it is also important to compare the strength of your abduction to the other side. Frederickson et al(2000) conducted a study on 54 runners and found that hip abduction was weaker on the affected leg for all participants with Illiotibial band pain syndrome(ITBPS) and that pain reduced with direct strengthening of the abductors.

Another symptom often associated with the ITB is pain over the greater trochanter (hip bone). This can again be caused by friction over the area due to tightness in the ITB or snapping of the TFL/ITB tendon over the greater trochanter. Conservative self-treatment of this condition would be much the same as with the knee pain and would involve the use of ice and lengthening of the surrounding structures.

As a runner, the demands on the ITB are very high, therefore it is important to take good care of this structure and maintain as much length as possible. If you do ever experience pain in either the lateral hip or knee, both abductor strength and ITB length should be addressed immediately. Lengthening of the quadriceps and hamstrings would also be advised in order to make quicker progress. Remember, however that ITBPS is most commonly associated with OVERUSE and therefore a look at your training diary would be worthwhile. Too many miles in un-supportive shoes or a rapid increase in mileage are two of the most common causes of short term ITBPS!!!


Fredericson M, Cookingham CL, Chaudhari AM,Dowdell BC, Oestreicher N, Sahrmann SA. (2000). Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome. Clinical Journal of Sport Medicine. 10. (3). 169-175

Taunton, J.E., Ryan, M.B., Clement, D.B., McKenzie, D.C.,Lloyd-Smith, D.R., Zumbo, B.D., (2002). A retrospective case–control analysis of 2002 running injuries. British Journal of Sports Medicine 36 (2), 95–101.

United Health, Kent. (2012).Knee Pain – Cyclists and Runners. Availible at: