Physiotherapy & Sports Injury Clinic, Islington, London

Marathon Special – What Runners should know about Iliotibial Band Syndrome

Iliotibial band syndrome ITBS is the most common running injury of the outer knee, and comprises 22% of lower extremity injuries. The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. This band is crucial to stabilising the knee during running.

Because the most notable symptom is typically swelling and pain on the outside of the knee, many runners mistakenly think they have a knee injury.

Common causes of ITBS

Certain factors may make you more susceptible to ITBS. Weak hip muscles such as gluteus medius are thought to be a significant factor. Also over-pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. This can include wearing worn-out shoes, running downhill or on banked surfaces, running too many track workouts in the same direction, or simply running too many miles.


In the acute phase ITBS is managed by activity limitation or modification, and measures to relieve pain and inflammation, such as ice and oral NSAIDs.

Later on treatment consists of stretching of the iliotibial band and related structures, manual therapy techniques to release myofascial restrictions in the iliotibial band and other structures, and taping. Strengthening of the hip muscles and improving lower limbs biomechanics is also very important.

If conservative treatment fails, cortisone injection might be considered. Surgical intervention would be the last option.

It is interesting to note that IT band syndrome afflicts seasoned runners almost as much as beginners. If you are preparing for the London marathon and suspect that you may have ITB syndrome, contact us for a check-up, advice and if necessary treatment.

Juncal Roman is a specialist musculo-skeletal physiotherapist and has a special interest in running injuries and biomechanics

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Established in 1998