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Dispelling the myths about ITB Syndrome


Dispelling the myths about ITB Syndrome

Imagine running along and feeling pain around the outside of your knee. It’s not too bad so you continue on a bit further, after all, you have a race in just a few weeks time and you only started training recently. After running down a steep hill, the pain sets in a bit more fiercely and makes you think twice about continuing, but your marathon is fast approaching and you feel very unfit.  Fast forward a few more minutes and after a few more hills and you can now barely jog. Each step is met with the feeling like a knife is being stabbed into the side of your knee. You finally surrender and stop running.


As you unexpectedly cut short your run, you’re filled with a sense of fear. The strong stabbing pain on the side of the knee is scary. Thinking that this is a permanent injury to your knee is even more worrying. As you hobble home, slowly-but-surely your limping becomes walking, and eventually, the pain begins to subside. Without thinking, you run across the road to avoid an out of control Lime scooter and realise that your knee is no longer sore and you can run again! That is until the next downhill descent and the searing pain and panicked thoughts of knee surgery return.


Welcome to ITB Syndrome – a painfully frustrating, and a frustratingly painful injury. It is the curse of the over-enthusiastic runner but also affects lazy runners that neglect doing strength work. While no one plans to get injured, it usually affects those that fail to follow a plan, or worse still, are following an overly aggressive plan (too many miles too soon).


The ITB (Illio-Tibial Band) is a long tendon-like band that runs from your hip to the outer side of the front of your shin. It has a role in stabilising the knee and is spoken about with hushed tones in running communities. It is frequently demonised, but much like other maligned subjects, this fear is misplaced. True, the ITB has a role in ITB Syndrome but not in the way it was traditionally thought – hence why traditional treatment approaches frequently fail.


For years ITB Syndrome was referred to as ITB ‘Friction’ Syndrome based on the idea that the ITB was causing rubbing on the side of the knee. Given that the ITB is well anchored around the knee, it is unlikely that it has sufficient freedom of movement to actually achieve this. IT Bands are often diagnosed as being ‘tight’ however there is a lack of contractile tissue in it for the actual band to become tight or otherwise – hence why efforts to stretch or release tension (e.g. by using a foam roller) are largely pointless.


ITB Syndrome is not a true knee injury. While the injury pain is felt near the outside of the knee – and often feels worse with knee movement – there is not usually any damage to the actual knee joint. Instead, the pain comes from irritated soft tissue on the femur (thigh bone) external to the knee, and reducing this pain is the initial goal of treatment. From there, identifying and correcting the causative factors is important.


One of the more common factors linked with ITB Syndrome – and in fact most running injuries – is training errors. Increasing the volume and intensity of running too much over too short of a time period is a large risk. Additionally, doing too much downhill running also heightens your chances of ITB Syndrome developing.


ITB Syndrome is frustrating, and simply not running for several weeks or months is not the answer. You may no longer feel pain when walking or running short distances, but the pain is likely to return again within a few kilometres of running. Some injuries you can run with and they will warm up and settle. This is not one of them. Instead, it requires an active approach to rehabilitation whereby any muscle imbalances are identified and rectified. Running technique can play a part in the development of the injury. Overstriding (landing on an outstretched leg too far in front of your hips) seems to have a role, as does running with too slow of a cadence (foot strike rate).


Returning to running after having ITB Syndrome requires a measured approach, and a cautious increase in running distance is recommended. It is also suggested that downhill running should be minimised at this time, and care taken with running technique. For those returning to run, a running plan devised by a running specialist is recommended.  Or better still, these issues could be avoided by following a custom running plan designed with your running goals and injury risk profile in mind.

  1. Foam rolling fixes ITB syndrome
  2. You should run through the pain of ITB syndrome
  3. All you need is rest.


If you have been suffering pain from running, or are returning to running after having ITB syndrome, take action and have one of intraining’s podiatrists or physiotherapist help you return to running.  BOOK AN APPOINTMENT HERE.


By Doug James – Physiotherapist and Podiatrist

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