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Iliotibial band syndrome

Updated: Jun 17, 2020

Someone cycling  going down hill

Iliotibial band syndrome (ITB-S) is a lateral knee pain. This common knee injury is frequently seen in runners and cyclist and is often referred to as ‘Runner’s Knee’. Commonly very sharp in nature it is often causing immediate need to stop cycling or running.

The iliotibial band (ITB) is a long tract of connective tissue (fascia) that originates from two muscles - glute max and tensor fascia lata. It runs down the outside of the thigh, crosses the side of the knee and attaches on the outside of the shin bone towards the front.

The ITB contributes to lateral movements of the leg, stability in single leg stance and control of rotational movements at the knee.

What causes Iliotibial band syndrome?

This injury arises due to the repeated rubbing of the ITB against the outer part of the lower thigh bone (femur). A fluid-filled sac called a bursa normally helps the IT band glide smoothly over your knee as you bend and straighten your leg. It is primarily an overuse injury from repetitive movement.

Anatomical drawing of a leg showing the site pain on the leg and the iliotibial band

Risk factors:

  • Weak gluteal muscles

  • Quads muscle weakness

  • Greater 'Q-angle' hip to knee width ration

  • Poor flexibility in hamstrings

  • Incorrect saddle height and cleat orientation

What are the symptoms?

  • Pain on the outside of the knee that is felt during activity and often for quite some time afterwards once aggravated.

  • Most painful between 20-60 degrees of knee bend.

  • Extremely sharp pain, to the point where it becomes difficult to continue the activity.

  • Pain and tenderness that are easy to reproduce by compressing the affected area

  • A feeling of stiffness when bending and straightening the knee, on the outside.

How to manage Iliotibial band syndrome?

Activity modification

  • If the pain has become acute then it is vital to stop cycling in the short term to allow the area to settle. You may wish to replace your cycling with other forms of cardiovascular training to maintain fitness. Swimming is the best first choice when symptoms are severe

  • Icing will immediately help to ease the acute pain and possible inflammation present.


  • Strengthening The particular focus of strength training should be on the quadriceps, gluteals, and hamstrings Here is a nice starter gluteal drill that you can do while the knee is too sore for other training.

  • Stretching If you have tightness in your quads or hamstrings focus on increasing flexibility around these two muscles. Stretching the ITB itself has not been shown to be very effective.

  • Manual Therapy / Sports Massage For those suffering from painful and ‘knotted’ quads, especially the lateral quad, and also the gluteal muscles, sports massage can alleviate these symptoms around your knee.

Bike Fit

  • Saddle height is almost always the primary issue linked to ITB problems when it comes to bike fit. Generally speaking a saddle that is too high will lead to ITB issues whether a saddle that is too low may link to other knee problems - as with all cases these are not hard / fast rules and need to be examined / tested on an individual basis.

  • Stance width can also be adjusted to reduce adduction at the hip

  • Cleat wedging may be useful to reduce valgus (inward) collapse of the knee and reduce rotational forces during the pedal stroke

Anti-inflammatory medications

Anti-inflammatory medications such as ibuprofen can be helpful but there is no direct evidence for their use in helping to manage this condition. You must consult with your GP or physician before starting any course of medication.

Injection Therapy

Corticosteroid injection is the most common injection therapy. Corticosteroid is a strong anti-inflammatory drug that reduce pain and inflammation in the short term. Use of botulinum toxin (Botox, Dysport etc). It is injected into the tensor fascia lata muscle at the top of the thigh to temporarily paralyse its function. Injections combined with physiotherapy rehab allow to achieve best outcomes.


A number of different approaches have been considered to manage more recurrent or resistant cases of ITBS. These involve attempting to lengthen the ITB, excising inflamed ITB tissue or bursectomy (removal of the inflamed bursa tissue lying deep to the ITB).

What else could it be?

If you are having issues with your knee and want to get in touch about booking a consultation or a bike fit then please email us:

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