ITB Syndrome (foam rollers begone!)

Iliotibial band syndrome (ITBS) is one of the most common causes of lateral knee pain, especially among runners, walkers, and cyclists. If you experience pain on the outer knee during or after exercise, or discomfort while climbing or descending stairs, you may be dealing with ITBS. Left untreated, this condition can become a chronic issue, limiting your ability to stay active and enjoy your favorite activities.

What is the Iliotibial Band (ITB)?

The ITB is a thick, fibrous connective tissue that runs from your lower back and hip, down the outer thigh, and attaches to the outer part of the knee. For years, it was thought that ITBS resulted from friction between the ITB and underlying structures, leading to pain and inflammation. This led to the widespread belief that ITBS was caused by a tight ITB, and countless athletes spent hours on a foam roller or undergoing painful deep tissue massages to “loosen” the band.

However, recent research shows that the ITB is an incredibly stiff and durable structure, requiring hundreds of kilograms of force to stretch it even slightly. So, if you’ve been rolling, stretching, and massaging your ITB without results, you’re not alone—these techniques likely do little to address the actual problem.

What Actually Causes ITBS?

Rather than tightness, ITBS is often linked to poor biomechanics, muscle imbalances, and overuse. The hip and knee muscles play a crucial role in controlling how much stress is placed on the ITB. Weakness or lack of control in these areas can increase strain on the band and the tissues underneath it, leading to pain.

Common causes of ITBS include:

✅ Overuse or increased training volume too quickly (e.g., suddenly increasing your running distance)

✅ Weakness in the hip abductors and glutes

✅ Poor running mechanics or excessive inward knee movement (valgus collapse)

✅ Inadequate recovery or improper footwear

✅ Training on uneven surfaces or excessive downhill running

Best Treatment for ITBS: What Actually Works?

Since tightness isn’t the issue, the most effective way to treat ITBS is by addressing strength and movement control in the hip and knee. Instead of wasting time on ineffective foam rolling, focus on reducing aggravating activities (e.g., temporarily decreasing running volume) and incorporating targeted strength exercises.

Here’s a progressive ITBS rehab program, moving from easier to harder exercises:

🔹 Beginner Exercises (Low-Level / Easy) ✅ Side-lying hip abductions – Strengthens the glute medius, which stabilizes the knee. ✅ Glute bridges – Activates the posterior chain to improve hip control.

🔹 Intermediate Exercises (Moderate Level) ✅ Squats – Encourages proper knee alignment and builds overall leg strength. ✅ Step-ups – Helps with single-leg control, mimicking real-life movement patterns.

🔹 Advanced Exercises (High-Level / Hard) ✅ Single-leg squats – A crucial test of hip stability and knee control. ✅ Banded hip abductions – Further strengthens the lateral hip muscles.

To see real improvement, expect at least 6-8 weeks of progressive strength training before increasing your running or walking intensity. Since muscle adaptation takes time (typically 5-8 weeks), patience and consistency are key.

Returning to Running & Injury Prevention

Once you’re back to running, maintaining 1-2 strength training sessions per week is essential for injury prevention. This should include compound movements like:

🏋️‍♂️ Lunges – Improves single-leg stability.

🏋️‍♂️ Squats – Builds overall leg strength.

🏋️‍♂️ Deadlifts – Strengthens the posterior chain.

🏋️‍♂️ Step-down exercises – Mimics the knee control needed during running.

Why is strength training so important? Because it not only reduces future injury risk but also enhances your running performance—meaning less time in the physio clinic and more time hitting the pavement pain-free.

Struggling with ITBS? Let’s Fix It!

If ITBS has been limiting your training or keeping you from your favorite activities, sports physiotherapy can help. A tailored rehab program can correct movement imbalances, improve strength, and get you back to running pain-free.

📅 Book an appointment at PhysioPM today – your trusted sports physiotherapy clinic in Townsville – and let’s build a plan to get you back on track! 💪🏃‍♂️