Iliotibial Band Friction Syndrome — Part II

Iliotibial Band Friction Syndrome — Part II

Iliotibial Band Friction Syndrome — Part II


As described last month, ITBFS can be a persistent, annoying problem that is often resistant to standard treatments such as ice, rest, stretching, etc. Frequently, the runner will stop running for 2-3 days or even weeks, only to have the pain return immediately upon resuming the activity.

For some people, this just becomes a chronic ailment no matter how much they “Nupe-it.” Why is this?

To answer this question, one would have to know the underlying cause for ITBFS. There are many theories out there on this, but what they all have in common is the belief that ITBFS is essentially a classic biomechanical injury. What they disagree on, however, is exactly what the biomechanical fault is that leads to this problem. I don’t have the time or space to list all the theories, so I’ll just give you my own. (Actually, it comes from the work of an internationally recognized physical therapist/neurobiologist, Shirley Sahrmann — I have to give credit where it’s due!)

Although the pain of ITBFS is felt in the area of the knee joint, this isn’t where the problem originates. As I described last time, the ITB starts up by the hip, joining two muscles which attach to the pelvis. If a strength/length imbalance develops between these two muscles, an imbalance of rotational forces at the hip joint can result. Specifically, the typical pattern is for there to be stronger internal hip rotation as the more forward muscle becomes overpowering. This not only changes the gait pattern, it also pulls the entire ITB more forward in the knee area. This makes it more susceptible to rubbing over the bony prominence on the lower end of the femur which inflames the tissue.

How does this imbalance happen? Well, sometimes it can be related to running in worn shoes or on crowned roads, both of which happen to be commonly cited reasons for ITBFS. More often though, I think it goes back to postural habits, such as persistently bearing weight on one particular leg, or crossing one leg over the other when sitting, as I mentioned in an earlier column. One way you can tell if you have developed this is to lie on your back with your legs out straight. Relax completely, letting your legs fall out where they may. Lift your head and look at your feet. If they do not tilt outward at the same angle (say, the left foot is pointed at 10:00 while the right says 1:00), you may have this type of hip rotator imbalance. If you suffer from ITBFS, I’d be surprised if you didn’t.

Correcting this problem though exercises to balance the affected muscle groups is often more complicated than what I can describe here, but I hope this has given you some understanding of the nature of this seemingly common running injury.

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).