• www.sportordination.at
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  • www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at

Runner's knee/Iliotibial band syndrome (ITBS)

This is a pain syndrome that primarily occurs in runners and is therefore also known as runner's knee. Additional synonyms include: iliotibial band syndrome (ITBS) or band syndrome, as it affects the iliotibial band. The iliotibial band is a strip of fascia (fascia = a band of wide-stretching, tendon-like sleeve over muscles) that supports the musculature on the lateral side of the thigh and runs from the iliac crest downwards to be anchored to the head of the tibia.

Pain therefore primarily occurs because the band rubs on the joint protrusion (= epicondyle) of the femur, like a rope on a cliff edge. This can lead to overexertion and irritation of the skin on the leg and the bursa mainly in long-distance runners or mountain climbers. ITBS occurs particularly frequently after longer periods of running down mountains - it is a pain syndrome, however, that is known to be painful in many long distance runners.

ITBS is generally the most frequent cause of pain on the lateral side of the knee. It is also widespread in cyclists.

ITBS often occurs in runners who have the following problems:

  • varus leg axes (= O-legs)
  • overpronation in the pushing off movement
  • weakness in the pelvic stabilisers, whereby the non-weight-bearing hip sinks and there is excessive pull on the band.



ITBS is indeed indicated as harmless, however the pain can be markedly severe and stabbing, making running impossible (I myself had ITBS when taking part in the Florence marathon). The fact that the pain only initially occurs when running is typical for band syndrome, however it can also become noticeable later when walking. Some runners are torn away from training for months as a result of band syndrome and inadequate treatment...

As the iliotibial band runs to the head of the tibia, the pain that comes from the epicondyles (see above) projects into the knee joint or to the lateral side of the tibial head. The projection of pain towards the head of the tibia is the reason the cause is often not identified. As a result, many runners have been treated unsuccessfully for meniscus and cartilage problems, despite their problem actually being band syndrome.



Typically crepitations over the femoral condyles, possibly also a type of crackling, is indicative of irritated tissue. The region is often also tender on palpation. In case of doubt, an MRI is advised, with which other causes can also be ruled out.



In the acute phase, the following should be carried out: cryotherapy, a break in training (also no cycling as the band rubs over the condyles painfully here too), anti-inflammatory ointments or plasters (which should contain Diclofenac or something appropriate), consistent exercises to stretch the band, strengthening exercises for the pelvic stabilisers and the stomach and back musculature.

Physiotherapy is a must to bring the ITBS symptoms under control. During this, exercises to stretch the often shortened band must be learned, preferably in combination with active friction therapy carried out by the physiotherapists caring for the patient.

In the case of varus leg axes, sport insoles should be prescribed where necessary. The majority of runners that come to me in the surgery with band syndrome, however, are overpronators and run with unsuitable running shoes. Carrying out a treadmill analysis in a specialist shop is therefore quite crucial to make sure you are running with the correct shoes.

Once the pain has disappeared and you want to slowly begin training again, you must warm up the affected region of the band in the knee area before partaking in sport (either with a heater or with thermal ointment). Exercises to stretch the lateral thigh musculature (primarily the tensor fasciae latae muscle) are very important, e.g. by crossing the legs when standing or lying down.

You should avoid long-distance runs in the first few weeks after commencing training. Cooling with cryopacks must be carried out after sport.

Running downhill should be avoided.

In the event that all these measures prove unsuccessful, or if you are close to a marathon that you have been training for for months, infiltration with cortisone can lead to a rapid improvement in the symptoms.

Once all conservative treatment measures have been fully exhausted with no success, an operation can alleviate the symptoms or lead to significant improvement in the symptoms. The band is cut in a z-shape during this operation and is lengthened and relieved as a result. In runners with very pronounced O-legs, straightening of the legs should certainly be discussed.


Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.