Posted on August 7, 2013

Iliotibial Band Syndrome (ITBS) is a common injury in runners of all levels that is caused by friction between the iliotibial band and the outer aspect of the knee or hip.  When the knee reaches 20 to 30 degrees of flexion, the iliotibial band is closest to the outer aspect of the knee which may produce friction and pain.  This syndrome, which can be very painful, can be brought on from running downhill, uphill or at a slower pace, all of which place the knee at a lower flexion angle in the 20 to 30 degree range. Runners with anatomic variations of the leg that place it in an inwardly rotated position may predispose to this condition. Flat feet (pronation), knocked knees (valgus) and weak outer hip muscles are all associated with an inward position of the leg.

Dr. Timothy Green examining a patient experiencing pain caused by ITBS.

IMG_2560Developing outer hip or knee pain after 2-3 consecutive runs may be a sign of ITBS. An adequate period of rest is the most important course of action in alleviating these symptoms. Continuing to run through the pain will only serve to worsen the symptoms. A proper warm-up and stretching of the iliotibial band is paramount in relieving and preventing ITBS.  Continued outer hip or knee pain at baseline or with the resumption of running after a 10 day to 2 week course of rest should warrant an evaluation by a sports medicine physician.


The majority of ITBS resolves with the appropriate non-surgical management. This may include formal physical therapy, anti-inflammatory medication, or an injection of cortisone or platelets. In rare cases that fail a long course of non-surgical management, arthroscopic surgery to remove the inflamed tissue and loosen the tight iliotibial band maybe necessary.