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Iliotibial Band Syndrome

Noninvasive Solutions for Runners

Lalonde, François M.Sc., CSEP

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doi: 10.1249/FIT.0b013e3182a0671a
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Running is becoming a popular way of staying fit and healthy. Just look around your community, and you will see plenty of runners. Many running events are sold out rapidly. Sadly, runners (typically beginners) often injure themselves while training for particular events such as a marathon. Iliotibial band syndrome (ITBS; also known as IT-Band or lateral runner’s knee) is a common overuse injury among runners and triathletes (3). The aim of this article is to help coaches and personal trainers to manage ITBS, with collaboration with other health professionals.


The constant rubbing of the band over the lateral femoral epicondyle combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed (4). The runner feels the pain on the lateral side of his or her knee when he or she runs for a few kilometers. The pain usually disappears when running is stopped or suspended. Several risk factors (other than anatomical or genetics) may contribute to the development of ITBS, such as training errors, including rapid changes in training routine, hill running, excessive striding, and increased mileage. The type of surface of activity also can contribute to the development of ITBS in runners; downhill running tends to be worse because of the decrease in knee flexion that is present at the time of the foot strike, thus increasing the forces experienced by the knee (5). All those factors are manageable easily with a well-balanced training program, although it is always recommended to consult a physician and a physical therapist when experiencing any pain. Nonsurgical management remains the mainstay of treatment of symptomatic ITBS (2). Rest from the culprit activity, such as running, until pain has resolved, followed by a gradual return to activity as tolerated, may help to avoid symptom recurrence. If the pain occurs only while running, it is recommended to include pain-free cycling training as well as swimming sessions. An optimistic rehabilitation is expected to last between 6 and 12 weeks without symptoms but, after rehabilitation, it is important to manage risk factors and include specific exercises in your routine.


Many risk factors are avoidable easily with balanced training that suits the needs of the client. For this reason, it is important to assess your subject to set a pain-free training. As a reminder in your evaluation, it is important to consider the goals of the individual, his or her running and sports history, a list of previous injuries, his or her body composition, his or her running technique (if possible, film the running technique), the type of shoes the athlete is using, his or her aerobic capacity, and an assessment of his or her core strength and muscle imbalance.When assessing the running technique, make it simple!Here are three major points that will accomplish this objective:

  • How does the foot strike the ground? Many runners are heel strikers, and the optimal landing should be on the forefoot. Testing the runner with his or her shoes on and barefoot is another way to assess what type of shoes is indicated to have a better running technique. As an example, if one is a major heel striker with his or her shoes and lands on his or her forefoot while he or she runs barefoot, then maybe a minimalist shoe or light trainer is a good option because it will increase the foot’s proprioception.
  • What is the cadence of running? Count every strike or stride in 1 minute. The goal is to be approximately 180 strikes per minute. This simple assessment will often correct the length of the strike.
  • How is the runner’s body orientated while running? Is the subject’s body straight, leaning backward, or leaning forward? The goal here is to use gravity as an advantage while running. So leaning forward (with the body straight) will help being more effective. If one is not able to take that position, maybe he or she needs to get into core training.

Readers are directed to ACSM’s Health-Related Physical Fitness Assessment Manual for the details of a full fitness assessment. Once the assessment is completed, you know better what to work on with the runner to achieve his or her goals. Your training plan should include many aspects: technique, increasing speed, increasing endurance, strength training, strategy, mental visualization, and flexibility. The key is to partition the weekly training among all these aspects using the right proportion for the clients’ need. Always keep in mind that the body adapts itself to new stress and at a different pace! However, when the runner goes beyond the adaptation threshold, injury will often arise. To avoid this problem, when building training programs, the key is to consider the mechanical impact of exercises (Table). Following this basic principle will prevent many injuries as well as ITBS. As an example, the objective of a training session is to increase the V˙O2max with a new runner. To reduce the mechanical impact of running intervals, I would suggest doing the same interval on the bike or elliptical machine. As the client’s body adapts in the season, I gradually would transfer the interval sessions to running.

Mechanical Impact of Exercise


The coach’s role in rehabilitation is to find out what could have caused the injury with the help of other health professionals and to do proper modifications to the training sessions. First of all, it is important to review the client’s training programs because the problem probably lies on how it is built. Has there been a drastic increase in intensity or frequency of training? If so, it is important to allow the body to adapt and slowly increase intensity and frequency at a 5% to 10% rate per week. Has the landscape of the training changed? Training on a flat road and then suddenly starting uphill/downhill training or cross country may cause ITBS. Note that cross country is not recommended while recovering from ITBS. Again, adapt slowly to the new landscape of training. It is important to help the runner to be attentive to his or her body’s reactions and gradually increase frequency and intensity and to allow some time for his or her body to adapt. When training is beyond the adaptation threshold, there is risk to get injured or to fall back in an old injury pattern. While injured, try to reach cardiovascular intensity through the practice of sports that do not cause injury-related pain such as swimming or cycling (Table). Another important point: don’t forget that rest is part of a training plan; make sure to get at least a full day of rest in your week. Most of the time, a well-prepared training program will prevent injury and also help a good recovery. Besides the modifications to the training program, coaches can suggest specific strength training and flexibility exercises.


Specific exercises are recommended in the management of ITBS. The suggested exercises can be used in prevention and rehabilitation from ITBS. Exercises are divided into three categories: strength training, flexibility, and core training (1,6).

The step-down (Fig. 1)

Figure 1
Figure 1:
The step-down. In the picture: Samuel Roy, Elite U17 triathlete. Pictures are taken at Physioproaction Clinic, Chambly, PQ.

Key points: Make sure that the spine is straight and that hip, knees, and heels are aligned.

Exercise parameters: 3 sets of 15 to 20 repetitions, with 60 seconds of rest between sets. The tempo is very important for this exercise: down in 5 seconds for the eccentric phase and up with the uninjured leg.

Hip abduction (Fig. 2)

Figure 2
Figure 2:
Hip abduction.

Key points: Make sure that the spine is straight and that hip, knees, and heels are aligned.

Exercise parameters: 3 sets of 12 to 15 repetitions at a 2-1-3-0 (concentric-isometric-eccentric-isometric) tempo with 60 seconds of rest between sets.

Wobble board stabilization (Fig. 3)

Figure 3
Figure 3:
Wobble board stabilization.

Exercise parameters: Get balance for 3 sets of 20 to 90 seconds, with 30 seconds of rest between sets.

Extra: If the exercise becomes too easy, one could try the step-down on wobble board.

Posterior chain stretch (Fig. 4)

Figure 4
Figure 4:
Posterior chain stretch.

Key points: Point the toes toward your pelvis. Try to flatten the lower back on the floor and point your fingers to the wall behind you.

Exercise parameters: 3 sets of 30 seconds’ stretch, don’t forget to breathe!

IT-Band stretch (Fig. 5)

Figure 5
Figure 5:
Iliotibial band stretch.

Exercise parameters: 3 sets of 30 seconds’ stretch, don’t forget to breathe!

Core training exercises (Fig. 6A, B)

Figure 6
Figure 6:
A, B. Core stabilization.

Exercise A

Key points: Make sure that the spine is straight and hold position.

Exercise parameters: 3 sets of 20 to 180 seconds, with 20 seconds of rest between sets.

Extra: If the exercise becomes too easy, try with your arms on a wobble board.

Exercise B

Key points: Make sure that the spine is straight and hold position.

Exercise parameters: 3 sets of 20 to 180 seconds, with 20 seconds of rest between sets.


This is a checklist that can be given to your client when ITBS is suspected:

  • Get a full physical assessment from your physician MD or DO.
  • Check the running technique (can be recorded on a video to identify technical corrections).
  • Determine the V˙O2max, maximal aerobic speed, running pace; it will help manage the cardiovascular intensity.
  • Modify the training programs (frequency, mode (swimming, etc.), intensity, resting periods, environment, and duration of training).
  • Establish realistic training goals.
  • Consider a run/walk progression during the injury (6 to 12 weeks) and include swimming or cycling trainings.
  • Include core training, specific exercise, and suggest stretching to the routine.
  • Make sure that the equipment is optimal: running shoes (neutral without all the unnecessary technology is a good option for most of the runners; be careful, minimalist shoes are not for everyone).
  • Ensure that the eating habits are appropriate to get the needed nutrients that help facilitate recovery (consult a certified dietician if required).
  • Recommend mental visualization of running without injury and a positive attitude…There is always something to learn from an injury.
  • If pain persists and there is no improvement through rehabilitation, a physician should be consulted.


As running gains in popularity, many sport injuries such as ITBS may occur. ITBS mostly is an overuse injury. It is our role to build a strong running program that includes the mechanic stress chart and specific exercises. With a good preparation and prevention, we can help the population run healthier. Running should be fun, and it is a good way of staying fit through life. Enjoy!


Iliotibial band syndrome is a common musculoskeletal running injury among runners. An efficient way to prevent injury is to let the body adapt, to have a good running technique, and to include proper strength training. Making sure to increase the training intensity and frequency adequately will help your clients in achieving their running goals without injury.


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Iliotibial Band Syndrome; Runner’s Lateral Knee; Running; Injury Prevention; Exercise

© 2013 American College of Sports Medicine.