Every runners nightmare – the dreaded ITB friction syndrome



With the major Sydney running festivals fast approaching, a very common overuse injury to try and avoid is the dreaded ITB friction syndrome. It’s like having the annoying feeling of trying to pay your credit card off – it takes a long time and it just keeps nagging at you.


What actually happens when this dreaded syndrome strikes?

The ITB is a long, thick tendon that runs along the outside of the thigh and knee. Its purpose is to give support to the knee. With repeated bending and straightening of the knee, the ITB and bursa rubs against the thigh bone (femur) on the side of the knee. This creates friction and irritation of the tendon and bursa. It’s just like having a blister, but under the skin.


Common causes

ITB friction syndrome is caused by a history of overuse and repeated mico-trauma. It can be a sign of fundamental training errors including:

  • A rapid increase in training
  • Excessive downhill running and running down stairs
  • Running on uneven surfaces

It is essential you look back through you training program with a fine tooth comb to assess changes to your training. You will then find that there is no coincidence that your training changes will have occurred at the same time your pain started. Therefore learn from your mistakes! And next time you want to increase your training, make the progressions smaller.


What do you feel if you have got it?

  • An ‘ache’ over the outside of the knee during and after runs
  • The pain may worsen to the point that you have to stop exercising and may limp after runs.
  • The side of your knee is particularly sore with walking/running downhill or going downstairs.


What you need to do about it

  • Rest: without appropriate rest the ITB will continue to be inflamed.
  • Training loads: need to be reduced. Reflect on your training program with your physio. Assess WHY this overuse injury started. Learn from your training errors, so in the future you make more informed progressions to training loads to ensure the ITB can adapt to the demands placed on it.
  • Reduce Inflammation: regular application of ice (20 minutes on, 1.5 hours off), will provide pain relief. Anti-inflammatories prescribed from your doctor may also assist.
  • Correct strength imbalances:
    • Get your quadriceps muscles stronger
    • Most importantly, improve the strength of your pelvic muscle stabilisers i.e. your buttock muscles, to reduce the load through the ITB. This is to help your knee track straight ahead when you run and not rotate in. This rotating in of the knee excessively loads up the ITB. See the pictures below – A is the correct alignment and B is the incorrect alignment. This can be improved – you just need to know the right exercises. That is what Physiotonic can help you with! Go to  http://www.physiotonic.com.au/what-we-work-on/gluteal-strengthening/ for more info.


  • Massage and stretching:

o   Stretching – you should be doing this regularly anyway, but if not.. get cracking! Stretch out your major muscle groups in the legs – gluts, calves, quads, hip flexors, hammies.

o   Massage and/or release trigger points down the affected leg. Get rolling on a foam roller daily.

  • Wear appropriate shoes for your foot type. Get advice from a sports podiatrist.
  • Other medical interventions:

 o   Injections: See your Sports Doctor for advice on a corticosteroid injection if the problem persists.

o   Surgery: to release the ITB may be necessary in the occasional case that fails to respond to the above measures. Further advice should be sought from an Orthopaedic surgeon who specializes in knee surgery. Physiotherapy rehabilitation is recommended post-surgery.


To help correct your muscle imbalances and prevent the dreaded ITB friction syndrome, enroll in a Physiotonic exercise class today. Visit www.physiotonic.com.au to get in touch with us. 


About Physiotonic

Physiotonic are expert Sports Physiotherapists who run group exercise classes. We focus specifically on buttock muscle strengthening, deep core activation and flexibility. This will help you improve your posture. We specialise in helping runners to improve their running technique and running efficiency. The Physiotonic blog has posts on all sorts of health and fitness tips to help get you on your way!

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