Iliotibial Band Friction Syndrome - What It Is and What To Do About It

By Rick Morris

There are a number of running related injuries that while not serious in nature can become chronic and cause major problems with your running career. Iliotibial Band Friction Syndrome (ITBFS) is one of them.

Your iliotibial band (IT) is a thick length of tissue that stretches down the outside of your leg from your pelvis to the top – outside part of your lower leg. During its journey from your hip to your shin, this band passes over the lateral side of your knee. That is where the problem lies. ITBFS occurs when this band becomes irritated and inflamed where it passes over your knee.

The symptoms of ITBFS include tightness on the outside of your knee and/or a burning or stinging pain at the same point. In many cases the pain is worse when you are running downhill.

Causes of ITBFS

• Running on a side slope – If you are running on a slanted surface, the IT of your downhill leg is stretched more tightly over the outside of your knee. The increased friction can cause ITBFS.
• Bowlegs – Bowlegs also cause your IT to be stretched more tightly over your knee. ITBFS can be a problem running on any surface with a bowlegged condition.
• Lateral Heel Striking – A very common cause of ITBFS is a foot strike in which you land on the outside of your heel. A foot strike of that type places lateral stress on your knee joint which increases the friction between your knee and your IT.
• Over Striding – If your foot strike is in front of your center of gravity you are over striding. Over striding is the most common form flaw and causes not only decreased performance but also a number of running injuries, including ITBFS. Over striding places more stress on your tensor fasciae latae muscle. This muscle is attached to your IT. The added stress pulls the band tighter across the outside of your knee and causes ITBFS
• Downhill Running – Downhill running can give you a double whammy if your running mechanics are not correct. Most runners tend to drastically over stride when running downhill. Over striding combined with the increased over striding time associated with running downhill places even more stress on your IT.
• Over pronation – Pronation is an inward rolling of your foot. Some pronation is normal and necessary. Over pronation causes excessive rotation of your tibia. That excessive rotation can place more stress on your IT.

Preventing ITBFS

• Strengthen Your Stabilizing Muscles – The function of many of your core muscles are to stabilize your pelvis during your running stride. If those muscles are weak your pelvis may unstable resulting in increased stress in your IT. You can strengthen those muscles by performing the plank exercise as well as hip abduction and squats
• Avoid Over Striding – Your foot strike should always be flat footed or ball of your foot first, directly under your center of gravity. You should not reach out in front of your body or land on your heel. This type of foot strike will remove most of the rotary forces in your lower leg and decrease lateral forces on your knee. See running form for more information.

Treating ITBFS

Mild cases of ITBFS can be self treated with rest and a gentle stretching program. After you are pain free begin strengthening your hip stabilizing muscles and concentrate on improving your running form. If you over pronate you may need to run in stabilizing shoes or use orthotic inserts. Check with your physical therapist for specific recommendations. Severe or chronic cases of ITBFS should be treated by a physician.