Iliotibial Band Friction Syndrome – A Runner’s Worst Nightmare

One of the most common causes of pain at the knee, hip, or both, especially in active individuals, is known as Iliotibial Band Friction Syndrome, or ITB tendonitis for short.

The IT Band attaches to the outside of the shin, so repetitive movement of the shin with a tight IT Band, as seen in running, causes friction or “catching” over the lateral aspect of the knee causing pain.

Wait, what’s an IT Band again? The IT Band is a thick, strong band of tissue that runs down the side of the leg from the hip all the way down to the outside of the knee. The band helps assist with muscles at the hip and the leg when they are being worked, especially during running or mostly any physically demanding running activity. It also helps with stabilizing the outside part of the knee as well.

But I’ve been running my whole life, why am I just getting pain now? That’s one of the biggest questions you’ll hear, and the truth is there really isn’t one good answer to this question. IT Band friction syndrome could be brought on by many things, but the most common causes are:

  • Overuse/Increasing of Training too quickly:
    You may be been training for the Broad Street Marathon or The Tough Mudder and you really wanted to go hard and prepared yourself for your own personal record time. Some people develop microtears, or small tears to the IT Band that your body normally fixes on its own with adequate rest. However, some people keep working harder and harder and puts increased demand on the IT Band until it eventually becomes inflamed and overworked and can’t repair itself adequately. Also, some people start too fast of an increase in higher intensity training, including increased periods of training and training on high stress surfaces
    (hills, woodland trails, etc.) This causes an increased demand of stabilization needed by the IT Band and the surrounding muscles.  Because of the size of the IT Band it will commonly work harder than the other muscles thus causing inflammation.
  • Return from Injury too soon/Faulty Biomechanics/Technique:
    Most athletes and runners after an injury will do mostly anything to return back to the action as soon as possible. Truth is, if a person returns to activity too soon without proper healing time, the person will usually
    compensate their running technique in order to relieve themselves from their pain. Because the body works as a chain, meaning the way your ankles are aligned puts a certain stress at the knees which puts a certain stress at the hips and vice versa, it can cause abnormal stresses to other parts of the body
    and causes increased stress at these sites, including the IT Band. Because this new stress puts increased forces at the IT Band, it is usually unable to take this stress for long periods of time and becomes overused and inflamed.
  • Running Route or Surface:  I’ll tell you right now that if you’re an active runner and love running on the side of the road you are already at an increased risk for developing ITB Friction syndrome due to the way the roads are naturally designed to curve. This causes you to run at an angle which causes the IT Band to become extremely tight on one side and weaker on the other. The side that becomes tight may start rubbing on the lower leg causing friction and pain.
  • Faulty Footwear:  Perhaps one of the most important tools to prevent injury for runners is proper footwear. Like I stated before, the body works as a chain. Because your foot is making contact with the ground it is at the bottom of the chain whatever stress is place at your foot affects your knees, which in turn affects your hips, pelvis, lower back, etc. all the way up to your head. Proper footwear contoured to YOUR feet could prevent abnormal forces at the ankle and save you not only from IT Band injuries but any sort of running injury in general.
  • Muscle Imbalances:  Like I previously stated before in the faulty biomechanics section, having a weak core as well as hip flexors and abductors (muscles that bring your leg up and out) is one of the biggest reasons people
    develop this condition. Because these muscles that are supposed to be used during running are weak and can’t undergo the strength and endurance needed during running, so other muscles near the hip and leg start to overwork and the IT Band unfortunately takes the fall for it becoming overused and inflamed.


Okay, so I think I may have this condition, now what? The
answer is simple but nails on a chalkboard for most people: STOP RUNNING. This
condition is an overuse injury, which means exactly what it says, it is being over used. So how do you fix it, stop using it. Okay, so you really can’t technically stop using it, but you can definitely take to high demand and stress off of it that running does. Ice is also another great modality to help reduce inflammation and relieve pain.  Seeking out physical therapy is the quickest way to rid yourself of this issue.  There are techniques that only a physical therapist can provide that will help alleviate the pain.  Myofascial release, or deep pressure to the tight areas of soft tissue trying to break up tightness, is also a great technique used with recovery.  This may also be accomplished by using a foam roller. The best way to recover, though, is to reduce activity and actively seek physical therapy treatment. It is also important think about your running environment and footwear and perform strength activities as need in
order to decrease demand and stress on the IT Band. Depending on adjustments
needed, one can expect to perform light activity in about a month or so and gradually return to your previous level
of conditioning with proper rest.

For more information on physical therapy services head to

We’re Hiring!
We have immediate openings for multiple positions. Everything from Physical Therapists to Admin Roles.

Scroll to Top