Iliotibial Band Friction Syndrome (ITB Syndrome) is the most common lateral knee pain. The iliotibial band is a very thick soft tissue on the lateral side of the thigh, which extends from the lateral side of the thigh to the outer and lower sides of the knee and the patella. When its flexibility is low, repeated movements of the knee may cause the ITB to rub with the femur, causing inflammation and pain, which is called Iliotibial Friction Syndrome. If the inflammation persists, it is more likely to hinder the normal movement of the patella and induce knee pain or other pain.

Self File | Iliotibial Band Friction Syndrome ITB_髂脛束磨擦綜合症 Knee Pain Causes, Physiotherapy Treatment1




Most people think that this is a phenomenon of excessive fatigue or inevitable degeneration, but the causes are actually complicated. In addition to the low flexibility of the ITB, abnormal body structures such as pronated feet and flat feet are prone to high friction of the ITB with its surrounding tissues. Besides, from the perspective of sports biomechanics, the weakness or uncoordinated strength of the medial knee muscles will aggravate the poor running postures (such as habitual internal rotation).

Self File | Iliotibial Band Friction Syndrome ITB_髂脛束磨擦綜合症 Knee Pain Causes, Physiotherapy Treatment2



Risk Factors

Studies have found that sports with repetitive movements (such as long-run) are more likely to cause inflammation than sports with changing orientation or at a fast speed (such as basketball, short-run, etc.). In Hong Kong, the long-distance race incurs many stair steps, such as the mountain races require participants to go down the mountain or to take the stair road and the ground is too hard, etc., which is more likely to induce this disease. In addition, Asians tend to have flat feet, and the busy pace of life makes participants less prepared and trained, which makes Hong Kong sports enthusiasts more vulnerable to this pain.



Common Symptoms
  • Insidious pain in the thigh or the lateral side of the knee during a competition.
  • Redness, heat, swelling, and knee pain
  • Difficulty in flexion and extension
  • Pain intensifies when going down the mountain or stairs
  • In severe cases, pain may be felt during daily life or at rest




Ice, electrophysical therapy, and anti-inflammatory drugs can effectively relieve inflammation, but reducing the friction and pressure of the ITB is the ultimate cure. The effect of ITB stretching is less ideal. Proper soft tissue release methods to loosen the ITB are more effective.

Self File | 髂脛束磨擦綜合症 ITB Iliotibial Band Friction Syndrome_膝痛成因物理治療運動3

Self File | 髂脛束磨擦綜合症 ITB Iliotibial Band Friction Syndrome_膝痛成因物理治療運動4



Since quadriceps have many adhesions with the ITB, stretching the quadriceps can help to relax the ITB. In addition, insoles that fit the foot and sports shoes can help correct abnormal biomechanical structures. Rigid tapes can correct the abnormal mechanical structures and reduce compression of the affected area.

Self File | 髂脛束磨擦綜合症 ITB Iliotibial Band Friction Syndrome_膝痛成因物理治療運動1

Self File | 髂脛束磨擦綜合症 ITB Iliotibial Band Friction Syndrome_膝痛成因物理治療2



Preventive Measures

The endurance training of the quadriceps, vastus medialis, gluteus maximus, and medius muscles is important, which can effectively reduce the poor running posture (habitual internal rotation, etc.) caused by muscle fatigue. When first returning to training, athletes should increase the number of miles according to the condition of the pain. For some serious patients or elite athletes, specific training for lower limb strength, knee flexion, and landing angle, frequency and duration are important, in order to gradually return to the previous level of performance.






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