There are a number of common overuse injuries that runners can pick up, for example, Illiotibial Band Friction Syndrome (ITBFS).

The Iliotibial band (ITB) is a tract of thick fascial tissue that runs down the lateral (outer) thigh. It helps provide lateral stability to the knee and the hip. It’s prone to becoming chronically tight when muscular imbalances occur around the hip and knee and stability at the hip is inadequate.

The most common characteristic of ITBFS is lateral knee pain – this is the result of the ITB band rubbing over the lateral femoral epicondyle (thigh bone) when the ITB is in a tightened state. The ITB becomes locally inflamed at this site of friction and can become chronically painful on walking and running.


In terms of symptoms, ITBFS presents differently depending on the severity of the injury. In the initial stages, a dull ache tends to come on around the lateral knee when running – often after 20-40 minutes. This pain usually persists or worsens if running continues, easing with rest. As the

injury progresses (usually by trying to continue training and ‘run through the pain’) this dull ache turns into a sharp pain leaving the local area tender to touch, even at rest.

Often a runner can train and race without pain and injury even with biomechanical problems i.e. poor running technique. The only effect they will experience is suboptimal efficiency i.e. they won’t be able to run as well as they should be able to. And most don’t even realise this is happening.

However, as training and racing load is increased, these biomechanical floors often manifest themselves and end up causing injury. Then the runner will know all about it – but by then it’s too late. With ITBFS this is certainly the case.

Biomechanically, there are a number of factors which can lead to tightening of the ITB and the increasing probability of developing ITBFS:

– The foot is commonly the first place many therapists look when analysing the biomechanical causes of ITBFS. Over-pronation (uncontrolled inward rolling of the foot upon foot-strike) can begin a chain of events, which ends up putting undue stress on the ITB.

Often an orthotic (specialist insoles) is prescribed to help support the foot and control the pronation. This can help as it adds control and stability to the kinetic chain from the ground upwards but it doesn’t take into account the forces acting top-down and technique related muscle imbalances around the knee and the hip.

This is where we, as therapists look more globally. The key lies in the specific biomechanics of the sport.

Common running injuries_2

Many runners who suffer from ITBFS tend to run with a quad and hip flexor dominant gait pattern, dragging the leg through using those anterior (front) muscles with each stride. With this common technique, the glutes and hamstrings do not engage.

This creates an imbalance around the hip and knee – the glutes and hamstrings do not fire adequately, and the quads and hip flexors over-work and become tight and overactive. As well as putting stress on the lower back, this imbalance causes the ITB to tighten up in compensation, increasing its friction over the lateral femoral epicondyle.

– Weak core muscles and poor pelvic and hip stability also add to the problem, the ITB will tighten up to try and provide stability where it is lacking (especially around the hip and pelvis) due to untrained stabiliser muscles.

– Runners with bow legs will pre-dispose the individual to ITBFS, in such cases, as in all, prevention is better than cure.

How to treat ITBFS 

In acute cases, rest from running is necessary, to allow the inflammation to settle down. Using the ‘RICE’ principal of Rest, Ice, Compression and Elevation is a sound rule of thumb here. As the pain decreases, massage and stretching will help release the tightness in the ITB itself. Many people ‘like’ to use a foam roller to self-massage the area regularly and with good results.

Alongside treating the symptoms and improving flexibility, close attention must be paid to the causes. Dynamic exercises to strengthen and stabilise around the hip, pelvis and core will help the body control itself better.

Alonside treating the symptoms and improving flexibility, close attention must be paid to the causes.

Single leg exercises are great in this respect. Specific glutes and hamstring exercises should be added to the programme to activate and strengthen these posterior muscle groups in preparation for learning to run again.

Learning to run 

This is the key to being able to return to training and racing pain free and preventing a recurrence of ITBFS.

Often when pain free runners return to running in the same way that they did previously, thus developing the same muscle imbalances and ending up with the same result again i.e. injury. It’s all well and good strengthening the correct muscle groups, but it’s necessary to teach these muscles how and when to engage during the actual motion of running.

Running technique can be taught just like any other skill. Teaching the leg to cycle under the body, engaging the hamstrings and glutes by raising the heel towards the backside, as well as correct foot placement and correct upper body biomechanics will ensure that the muscle imbalances which were originally created don’t build up again.

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