What is iliotibial band pain? | Flawless Physio | Advice Centre
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What is Iliotibial Band Pain?

What is the iliotibial band (ITB)?

The ITB is a very strong structure which is confusing as it is not definitively a tendon, ligament or just a dense fibrous connective tissue. In reality it is all three. It is a tendon by definition because it connects a muscle, the tensor fascia lata, to bone. It is a ligament because it connects bone to bone and limits unwanted movement to provide stability. And it is made of dense fibrous connective tissue.

The ITB is not only connected directly to bone but also to the surrounding muscles via further connective tissue. It connects to the gluteus maximus, quadriceps, hamstrings, gastrocnemius muscles and connective tissue around the patella (knee cap). So the state of all of these muscles can have an impact on the compressive forces of the ITB.

What are the symptoms?

Pain usually develops quickly during or after a particular activity. It is usually felt initially as a sharp pain on the outside of the knee that will often worsen if the activity is continued. The bony prominence on the outside of the femur bone just above the knee is where symptoms are most commonly felt. It is at this point that the ITB can get compressed against the bone. With the highest compression when the knee is bent to 20-30 degrees.

What causes ITB pain?

There is a small fat pad that sits between the ITB and this bony prominence to protect the soft tissue from the hard bone. It is this structure that becomes painful and inflamed with repeated compression, not the ITB that is actually causing pain.

ITB pain is very common in runners. However, it can occur after excessive or unusual down-hill walking and occasionally cycling. It can usually be linked with a change of type of exercise, intensity or volume. Contributing factors include poor muscle recruitment or weakness around the hip joint, running biomechanics, foot posture and fatigue. Therefore, ITB pain is very common with first time half or full marathons runners.


The first myth to bust is that this condition is caused by friction and it is sometimes call ‘Iliotibial band friction syndrome’. The band cannot move back and forwards therefore no fiction occurs. The issue is related to compression and inflammation of the fat pad.

Second myth to bust is that stretching, foam rolling or massaging the ITB will help. The ITB is an immensely tough structure and it will not be loosened or lengthened by foam rolling it.


For some helpful tips please read “How to avoid injuries or manage them during your marathon training“.

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