Running injuries – ITB syndrome

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With lockdown 2.0 here, and gyms closed for the rest of the month at least, many of you will be dusting off the running shoes and getting back out running. 

While this is great, and should be encouraged, I have been seeing a lot of people picking up running related injures as they suddenly increase their training volume and running miles during lockdown. 

This series of blog posts will look at some of the most common running injuries, including what they are, and how to recover from them. 

To avoid these injuries in the first place, remember to increase your training volume gradually, making sure you are giving your body ample time to recover from the stress of training. 

It’s also important to mobilise and look after your working muscles and joints, and in a week I’ll be sharing some simple exercises to help you do just that. 

For this week, we’ll be looking at the most common cause of pain to the lateral (outside) of the knee when running, ITBF syndrome. 

Iliotibial Band Friction Syndrome

What is it?

ITBF Sydrome is one of the most common overuse injuries amongst runners. It occurs as a result of friction between the ITB and the underlying lateral epicondyle of the femur. That repetitive friction causes inflammation and pain. 

Friction occurs near foot strike, predominately in the foot contact phase. Runners have an average knee flexion angle of 21 degrees at foot strike, with friction occurring at or slightly below 30 degrees of flexion. 

Predisposing factors

  • Width of ITB (can be large variations between individuals)
  • Downhill running (larger degree of knee flexion on foot strike)
  • Inappropriate training or footwear
  • Abnormal biomechanics – excessive pronation, varus alignment of foot or lower limb, excessive lateral tilting of the pelvis.


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. The best way to tell if you have ITBFS is to bend your knee at a 45-degree angle. If you have an IT band problem, you’ll feel pain on the outside of the knee. 


  • Avoid aggravating activities. Cut out downhill running if this is currently in your programme. If running on the flat is still causing pain, reduce the distance and volume of your current programme. 
  • Ice the area post run. 
  • Foam roll and/or mobility work on ITB, TFL, quads, hip abductors, rotators and extensors. 
  • Strengthening hip abductors and stabilizers


  • Make sure you have an adequate warm up
  • Don’t run in old, worn out trainers
  • If running on a track, change directions repeatedly
  • Avoid regular downhill running

Returning to running 

Resume running when there is no local tenderness over the area and the strengthening exercises for hip abductors and stabilizers can be performed without pain. Start by running on alternate days and avoid downhill running.

If pain persists seek the advice of a health care practitioner who will be able to give you a full biomechanical assessment and will be able to address any specific issues. 

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