Iliotibial Band Syndrome (IT Band Syndrome)


Your iliotibial band (IT band) is a long piece of fascia that runs from the lateral hip down along the lateral aspect of the thigh and attaching to the lateral knee. The IT band helps stabilize the knee as the joint flexes and extends.

Physicians thought that that ITB syndrome resulted from friction or irritation to a bursa under the ITB and commonly prescribed ice and rest to decrease the pain. The latest research shows that earlier theories suggesting that ITB syndrome was a "friction syndrome" were wrong – there is no bursa, and the distal band does not undergo friction-inducing movement.

So what is causing ITBS?

Simply – hypertonicity (tightness) or overdevelopment of the TFL and underutilization of the glute muscles predisposes patients to ITB syndrome. This problem is very common in runners, particularly those who run longer distances. Long distance runs result in repetitive loading of the posterior fibers of the ITB due to increased knee flexion and adduction that occur secondary to fatigue of the glute muscles.

The knee is servant to the mechanics of the hip and foot; and research confirms that strengthening the glutes will correct this imbalance and reduce symptoms of ITBS. In fact, the vast majority of patients who incorporate hip abductor strengthening into their ITBS rehab will experience symptom resolution within six weeks!!! But...

How do you strengthen the glutes without activating the TFL?

Unfortunately, most ITBS patients present with weakness in the gluteus medius and maximus on the affected side. Strengthening the glutes without overactivating the TFL is key and new research has examined how to accomplish this goal and have named the best exercise...

The clam exercise with and without resistance

Clam exercises with and without resistance are a preferred mode of hip abductor strengthening with minimal TFL activation, so we get activation of both gluteus medius and gluteus maximus with very little activation of the TFL.

In addition to home exercise, the following changes should be made for the athlete:

  • Lower the duration of exercise but not necessarily pace. Fast-paced running is less likely to aggravate ITB problems when compared to slower “jogging.

  • Patients should begin slowly and increase their distance by no more than 10% per week.

  • Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track. Running on a small circular track causes the inner leg’s ITB to work harder to prevent it from swinging medially. If track work is unavoidable, runners should reverse directions each mile.

  • Athletes should avoid running on wet or icy surfaces as these require greater TFL activation for stabilization.

  • Runners must avoid “crossover” gaits, which have been shown to aggravate iliotibial band problems.

  • Cyclists may need to adjust seat height and avoid “toe-in” pedal positions.

  • Initially, patients should avoid; stair climbers, squats and dead lifts.

References 1. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat, 2006;208:309-316. 2. Michaud T. The Real Cause of Iliotibial Band Syndrome Dynamic Chiropractic November 18, 2012, Vol. 30, Issue 24 Fetto J, Leali A, Moroz A Evolution of the Koch model of the biomechanics of the hip: clinical perspective. J Orthop Sci. 2002; 7(6):724-30. 3. Barton N. Bishop, Jay Greenstein, Jena L. Etnoyer-Slaski, , Heidi Sterling, Robert Topp. Electromyographic analysis of gluteus maximus, gluteus medius, and tensor fascia latae during therapeutic exercises with and without elastic resistance. The International Journal of Sports Physical Therapy Volume 13, Number 4 August 2018 Page 669 4. Fredericson M, Cookingham C, Chaudhari A, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med, 2000;10:169-175. 5. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-9.