ITB Friction Syndrome

What is ITB Friction Syndrome?

Iliotibial band (ITB) friction syndrome is a common overuse injury that classically causes a burning pain on the outside of the knee. The ITB is a thick band of tissue that runs from the hip to the outer part shinbone and helps to provide support and stabilize the knee joint. The ITB can rub against the outer part of the thigh bone, it can become inflamed and painful.

Who is at risk for ITBFS?

ITBFS is most common in runners, cyclists, and other athletes who participate in activities that involve repetitive bending and straightening of the knee. It is also common in people who have tight hamstrings or weak quadriceps muscles.

What are the main symptoms of ITBFS?


The main symptom of ITBFS is pain in the outside of the knee, usually noted during exercise and activity, which tends to settle rapidly with rest. The pain is usually worse during activities that involve repeated bending and straightening the knee, such as running, cycling, or climbing stairs. The pain tends to be well controlled at rest but runners will often describe a subtle but well localised burning discomfort building as they run. This may reach an intensity that requires them to stop due to pain. The discomfort then settles fairly rapidly with rest.

Other symptoms of ITBFS may include:

Localised swelling and puffiness in the outside of the knee

Tenderness to the touch in the outside of the knee

A popping or clicking sound in the knee

How is ITBS diagnosed?

A doctor can usually diagnose ITBS by taking a medical history and performing a physical examination. The doctor will ask about your symptoms and activities and will examine your knee for tenderness, swelling, and range of motion. They may also order imaging tests, such as an ultrasound or MRI to rule these findings and rule out other causes of knee pain. On ultrasound assessment your doctor may identify swelling/fluid in the outer part of the knee, where the ITB runs directly over the bony prominence, the lateral femoral condyle (LFC). They may also note discomfort in this region with ultrasound probe pressure over the LFC.

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How is ITBS treated?


Most cases of ITBS can be treated with conservative measures, such as:

  • Rest:

    Avoiding activities that aggravate the pain, such as running or cycling
  • Ice:

    Applying ice packs to the affected area for 10-15 minutes
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen, paracetamol or naproxen, can help to relieve mild to moderate pain.
  • Physiotherapy/Strengthening exercises:

    Strengthening the muscles around the knee joint, such as the quadriceps, hamstrings, and calves, to improve stability and support. It is also important to consider the mechanics of the knee and lower limb during running. Abnormal foot mechanics may adversely impact the knee and predispose to ITBFS. Podiatry input may also prove useful in these situations.

In some cases, additional treatment options may be considered, such as:

  • Corticosteroid injections:

    To reduce inflammation and pain

    At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a side-lying position on the bed with the affected knee facing upwards. The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions. The ITB injection is performed with a small dose of steroid and local anaesthetic, targeting the region deep to the ITB, superficial to the bony prominence (LFC). See injection video XX

    The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever. If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed. The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours). This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

  • Surgery:

    To release the ITB if conservative measures have failed to provide relief

    If you experience persistent pain or discomfort on the outside of your knee, it is essential to consult a healthcare professional for proper diagnosis and treatment. Early intervention can help prevent further injury and improve overall knee function.