Iliotibial Band Friction Syndrome — Part I

Iliotibial Band Friction Syndrome — Part I

Iliotibial Band Friction Syndrome — Part I


If an award were to be given for “Injury of the Year” the winner in 1991 would have to be Iliotibial Band Friction Syndrome (ITBFS). I have seen so many cases the past few months that I’m beginning to think it’s caused by a contagious virus!

Many runners have heard of this ailment and may even have some idea of what it is, but most do not really have a good understanding of its causes or effective treatment of the problem. But don’t feel bad — I don’t think many of us “experts” know either. So what follows are some “facts” about what it is (Part I) and “educated guesses” as to why it happens and what to do about it (Part II next month).

The Iliotibial Band is a broad, thick, connective tissue structure that can be thought of as the largest tendon in the body. It is located on the outer portion of the thigh, connecting two muscles (tensor fascia lata and gluteus maximus) at the front and back of the hip in a “Y” shape and then running down the thigh, past the knee joint, to attach to the front, upper portion of the tibia. It starts out on the upper thigh as a broad, thin sheath, but narrows and thickens as it approaches the knee. If you sit and feel around your right lower thigh at about “3:00” (the top of your knee being 12:00), you should be able to feel this structure fairly easily.

Problems arise because there is a bony prominence in this area on your femur. If, for some reason (to be revealed later), the ITB rubs the wrong way over this protrusion, the tissue becomes inflamed and painful. Although it is structured like a tendon (connecting muscle to bone), this injury does not present with the typical pattern of tendinitis. Usually, the runner is able to run without pain for a set distance, say 2-3 miles, before the pain begins. With continued running the discomfort becomes more intense until the individual is forced to stop completely. Almost immediately upon walking, the pain subsides, but it will return almost immediately if running is attempted again. The next day the pattern is repeated, with the pain starting at just about the same distance in the run. It is definitely not an injury that you can just run through! And, resting 2-3 days is almost never sufficient. This is a real problem!

According to the 1984 Bern Grand-Prix study, ITBFS accounts for 11% of all injuries sustained by runners. Most of the literature describes bow-leggedness, poor footwear and running on crowned roads as the major culprits responsible for this problem. But I think this is only partially correct and next month I will explain why.

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).