ITB syndrome – common problem, uncommon solutions!

  • ITB syndrome causes a diffuse pain across the outside of the knee, roughly in line with the kneecap, as the knee bends to 40° while weight bearing
  • There is no swelling and usually no tenderness to touch, although there may be a tender spot if the bursa is affected
  • The leg can feel weak or like it will give way when the pain grabs


  • If pain occurs while running, the pain causes the supporting muscles in the leg to reduce their activation (known as pain inhibition) which leads to further pain
    • The best response is to stop and walk for a short period (1-2min) before recommencing running at a faster pace
  • Anti-inflammatory tablets or gels don’t help but a strong heat or cooling gel (eg. Dencorub) can mask the pain, improving movement patterns and reducing the irritation to ITB
  • Improving leg rotation and foot pronation control with more structured footwear or orthotics will reduce the pain quickly and increase the rate of improvement from exercises
    • This assists in getting an immediate response to exercises and can be weaned off as the muscle control improves


  • The primary mechanism behind ITB syndrome is actually inwards leg rotation (from uncontrolled pronation or hip movement), not hip/ pelvis drop
  • Foam rolling at ITB can aggravate a sensitive bursa (pad) behind the ITB and worsen the condition
  • ITB syndrome is not due to shortened ITB length and stretching an ITB doesn’t change its length or pressure on the side of the knee


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