ITB Friction Syndrome

The iliotibial band (ITB) is a sheet of fibrous tissue on the outer side of the thigh. It starts above the hip joint and passes down the outer thigh, and attaches just below the level of the knee to a lump of bone on the front of the outer side of the top of the shin.

The ITB is important in maintaining good posture in the lower limb, particularly with activities such as running.

If the ITB is too tight then with excessive knee movements (particularly with running, or sometimes with cycling) it can rub on the prominent bit of bone on the outer side of the knee called the lateral epicondyle (this is where the lateral collateral ligament attaches to the femur). With too much repetitive rubbing backwards and forwards, the ITB can become inflamed, and this causes pain – ITB Friction Syndrome.

Typically, with ITB Friction Syndrome people tend to be fine when they first start running. However, after a certain period of time or after a certain distance (as the rubbing gradually causes increasing inflammation), pain builds up around the outer side of the knee, and this is often described as a burning type sensation. If this is severe then it can stop people from being able to run. With rest, the pain tends to ease off, settle and go away.

ITB Friction Syndrome is not actually dangerous. However, it can be very annoying, it can prevent people from being able to exercise properly, and it is also important to rule out other potential causes of knee pain.


The best investigation for ITB Friction Syndrome is an Ultrasound Scan. The sensitivity and pick-up rate of a scan is improved if you go for a run beforehand and make sure that the knee is actually as painful as possible at the time of the actual scan.

If there is any significant concern about there being any possible damage inside the actual joint (e.g. articular cartilage damage or a meniscal cartilage tear) then the best test is to get an MRI scan.


The best treatments for ITB Friction Syndrome are:-

  • Rest – you should avoid whatever specific activities might actually be aggravating the symptoms (especially running)
  • Anti-inflammatories
  • Physiotherapy – Physio is definitely the mainstay of treatment for ITB Friction Syndrome, and this consists of deep tissue massage, the use of foam rollers and ITB stretches. Your physio will also check your alignment, your posture and your running technique, as correcting these can help greatly.
  • In most patients, the above measures are sufficient to cure their symptoms. For those patients whose symptoms are severe and/or whose symptoms persist despite appropriate physio treatments, then one can then proceed with a steroid/cortison injection directly under the lower end of the ITB (at the level of the lateral epicondyle). The steroid acts locally as a very powerful anti-inflammatory. These injections are absolutely definitely best done under ultrasound guidance.
  • Only very rarely are a patient’s symptoms so severe and so persistent that surgical treatment is actually indicated. If necessary, the ITB can be surgically released (lengthened) to relieve some of the tension and to prevent the rubbing, and hence the inflammation. This is not a big operation, but it’s still better to avoid any kind of surgery, if possible – and thankfully surgical ITB release/decompression is very rarely actually needed nowadays.