iliotibial band syndrome

Knee pain in my bottom: A guide to the Iliotibial Band.

May 4th, 2011 by Phil Brown

The iliotibial band. No, it’s not some turn of the century musical outfit. It is a part of the body whose name is often banded about by runners, cyclists and triathletes as the reason for their niggling aches and pains…..”Oh, yeah….got a bit of ITB tightness…….yeah, it was all ok until I got ITB Syndrome…”  However, I get the feeling that  that the iliotibial band remains something of an enigma to many, even those who claim it as the culprit in their pain….

It is common for me to treat runners at  Muscle and Movement Health who are suffering from pain involving the ITB, but who are completely unaware of the existence of this part of their anatomy and how influential it can be in the progress of their training…..

Where is it?

Down the outside of your thigh. It’s the slightly flatter bit on the outside of your thigh. It  runs from the side of your hip to the side of your knee, tapering as it descends.

What is it?

The iliotibial band is a strip of something called fascia. Fascia is a network of connective tissue that invests all the muscles and organs of your body and wraps them all up in the shape of a human being. Among many other things, the job of fascia is to transmit the movement and force created by muscles through the joints of the skeleton. This particular job is important to remember when we are discussing problems connected with the ITB.

What does it do?

The iliotibial band maintains what we can call a dynamic tension between the hip joint and the knee joint. It is constantly tight, but sometimes gets even tighter. The iliotibial band is actually part of a longer band of fascia that runs from the base of the feet through the outside of the leg, spiralling up into the oblique abdominals, upper trunk and back and into the back of the neck.

When we walk or run, movement at the hip joint is translated through the thigh and into the knee and then ankle and foot. And back again! This happens all the time very quickly when we are walking. When we are running it happens very VERY quickly. ALOT of shock and movement is transmitted through the ITB by the muscles that it merges with at either end…..

How does it go wrong?

The muscles that merge with the ITB at the hip can get very tight and tired from training or overuse, or sometimes simply by the way we walk or our choice of shoes.

When the iliotibial band is too tight, it stops moving so freely over the tissues and structures that lie underneath it. This can cause friction and inflammation at  the knee end or the hip end, or both. A tight ITB can also pull on the structures around the knee joint and cause pain.

How does it get too tight?

The  powerful gluteus maximus (buttock) muscles that take such a powerful role in running merge with the iliotibial band at the side of the hip.  A smaller muscle at the front of the hip called Tensor fasciae latae also merges with the band.  When these muscles become too tight, this tension is communicated to and through the band.

Below the knee, the front and outside of the shin can also become tight and sore from overuse. This tension can also translate into the ITB, which we must remember is part of a longer, continuous band of longitudinal fascia.

Strenuous exercise, such as training  can cause overtightness and overuse in these muscles, as can injury to the hip, knee or ankle in the form of strains or sprains.

What does it feel like?

Tension problems in the iliotibial band can cause different sensations. Most of these can make you feel like you have an injury or problem in the knee or hip and sometimes the ankle or foot.

A common symptom of an overtight iliotibial band is pain on the outside of the knee and just below the kneecap. It is not uncommon for a client to attend the clinic at Muscle and Movement Health complaining of knee pain and a little worried that they have a problem in the joint itself.  This is totally understandable. ITB pain at the knee can literally stop you in your tracks.  The distal (bottom) end of the band merges with the lateral part of the patellar retinaculum, which is an area of retaining and supportive connective tissue at the knee.  Tension from a tight gluteus maximus (or bum muscle) will translate through the ITB and cause pulling and pain here at the knee.

Resulting pain can feel sharp and local at the side of the knee, front of the hip or side of the hip and bottom. Sometimes this pain transfers as an ache or pulling at the side of the knee and into the outside of the shin.


How can I get rid of it??????


Using  stretches for the gluteus maximus and the tensor fasciae latae muscles can be effective to release tension here as well as prevent recurrence in the longer term. General stretches to maintain healthy hip, knee and ankle mobility are obviously crucial for runners. Tightness and imbalance in these areas can result in movement patterns that encourage ITB tightness to develop.

The right footwear

Make sure you have made the right choice of running shoe for the shape of your feet and the way you run. ITB pain resulting from your gait (the way your body moves and your feet strike the ground as you run) is very common.  Go to a running shoe shop that offers gait analysis from experienced staff.  A change of shoes can sometimes completely cure an ITB related pain problem.

Don’t overtrain

A sensible training programme does not result in overtraining. Proper rest periods between training sessions and race events, plus some creative cross-training can ensure safety from injury and overuse.

Sports massage

Regular deep tissue massage can not only release you from the sometimes chronic cycle of  ITB problems, but also enhance your training progress and performance by speeding recovery between sessions and preventing build up of the tension in muscle fibres that leads to pain and injury.

Self – treatment

If you are suffering from tightness and pain in the areas discussed, there are some small and simple things you can do which may ease and sometimes clear up the problem. Try massaging deeply and slowly using a tennis ball or the heel of your hand into the outside of your buttock near your hip bone. You can also work in the same way into the “pocket muscle” tensor fasciae latae, which sits just below the crest of your hip at the top and outside of your thigh.

Foam rollers can also be effective if you use them slowly up and down the ITB from hip to knee.

Both these techniques can often clear up low level ITB gripes very quickly.

Strength and stability training

A very common factor in the development of ITB related pain is weakness in the gluteus maximus muscle. A weak bottom can ruin a good runner!

When these big buttock muscles are not firing in an optimum sequence, the stability of the hip is compromised. This results in a tightening of the muscles that stabilise the hip during dynamic movement. Also, weaker muscles tire and tighten quicker than trained and strong ones.

Many runners suffer from iliotibial band pain as a result of weak gluteus maximus muscles. Using isolation exercises to get them contributing more effectively to the movement of running can address a root cause of many running-related aches and pains.

For more information on how to address iliotibial band issues or if you have a chronic problem that is stopping you progressing in your training, contact us at Muscle and Movement Health to discuss how we can help!



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