Iliotibial Band Syndrome: Current Considerations

Iliotibial Band Syndrome (ITBS) is a common source of lateral knee pain but can be difficult to address and manage.

The ITB itself starts proximally at the hip and attaches distally on the lateral aspect of the knee on a prominence known as Gerdy’s Tubercle. The ITB is a non-contractile tissue in nature and plays an important role in pelvic stabilization when the hip and knee are undergoing moments of flexion and extension, like when running.

Previous perspectives on ITB syndrome proposed that the mechanism of injury was related to the sliding and, in turn friction on the insertion at Gerdy’s Tubercle and the underlying structures. What is being noticed is that the ITB is not able to slide in its tract and create friction. Instead, a compressive moment on the underlying structures of the ITB, rather than friction, is occurring at various hip and knee angles. This compressive moment prompts inflammation and, in turn, pain.

Management of ITBS is multi-faceted.

The ITB is there to store and disperse energy. With that, stretching of the ITB is not as efficacious as we once thought. Stretching of tissues like the ITB requires a significant amount of force to create a plastic change in the tissue. Generating such force is impossible in the home, clinic, or gym. Even if we were, it would be a detriment as then the tissue would lose its spring like function to stabilize the lateral aspect of the lower extremity.

Hip strength deficits into abduction and external rotation have been noted with ITBS, along with an increase in hip adduction angle (hip moving towards mid-line) when loading, like with running.

Per Geisler (2020), exercises for ITB can be approached in a 3 tiered manner:

Tier 1: low load exercises like bridges and side-lying hip abduction/leg raise

Tier 2: moderate load exercises like mini-squats, lunges, and step-ups

Tier 3: higher load exercises like goblet squats, single leg deadlifts or squats, and plyometrics

A gradual progression of loading the area, activity modification, global lower extremity strengthening, lower extremity mobility, and assessing other wellness considerations like sleep and stress are beneficial in addressing, treating, and managing ITBS.

About the Author:

Michael Marcello earned his Bachelor of Science degree in Kinesiology at San Jose State University and his Doctorate in Physical Therapy at the University of the Pacific in Stockton. Michael is experienced in sports medicine, orthopedics, and concussion exertional physical therapy. Michael appreciates and utilizes current evidence-based treatment/interventions, continuing education courses and exercise to promote optimal function and performance. Michael, a Bay Area native, enjoys exercising, watching sports and spending time with his family and friends. Michael is a 49ers, Giants, Warriors and Sharks fan as well.


Retrieved April 10, 2024: band-pathology-synthesizing-the-available-evidence-for-clinical-progress/

Retrieved April 10, 2024: Geisler PR. Iliotibial Band Pathology: Synthesizing the Available Evidence for Clinical Progress. J Athl Train. 2020 December 22. doi: 10.4085/JAT0548-19. Epub ahead of print. PMID: 33351908. Retrieved April 10, 2024:

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