Home > Blog > Physiotherapy > Iliotibial Band Friction Syndrome Physiotherapy

Iliotibial Band Friction Syndrome Physiotherapy

Iliotibial band syndrome (ITBS) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats)

Signs and symptoms

ITBS symptoms range from a stinging sensation just above the knee and outside of the knee (lateral side of the knee) joint, to swelling or thickening of the tissue in the area where the band moves over the femur.

The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time.

Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia.


ITBS can result from one or more of the following: training habits, anatomical abnormalities, or muscular imbalances:

Training habits

  • Spending long periods of time/regularly sitting in lotus posture in yoga. Esp beginners forcing the feet onto the top of the thighs
  • Consistently running on a horizontally banked surface (such as the shoulder of a road or an indoor track) on which the downhill leg is bent slightly inward, causing extreme stretching of the band against the femur
  • Inadequate warm-up or cool-down
  • Excessive up-hill and down-hill running
  • Positioning the feet "toed-in" to an excessive angle when cycling. (Knee should be positioned between 30-35 degree to help avoid ITBS)
  • Running up and down stairs
  • Hiking long distances
  • Rowing
  • Breaststroke
  • Treading water

Anatomical mechanism

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners.

The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity.

The continual 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.


Diagnosis of iliotibial band syndrome is based on history and physical exam findings, including tenderness at the lateral femoral epicondyle, where the iliotibial band passes over the bone.


While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Physical therapy, and many of its modalities, can offer relief if symptoms arise.

Stretches used to help:

  • Standing Stretch- 1.) Cross the uninjured leg over the injured one while standing. 2.) Lean towards the opposite side of the injured leg.
  • Iliotibial band rope stretch - 1.) Put injured leg in the bottom of the rope, slowly raising it to the ceiling. 2.) Cross leg over the uninjured leg. 3.) Hold this position for 15 seconds, then release. 
  • Hip Flexor Stretch - (Need a raised surface) 1.) Standing a small distance away from the front of a chair, take your right foot and place it on top of the seat. Your right leg should be bent at a 90 degree angle, with your left leg stretched straight behind you. 2.) After holding it for a couple of seconds, go back to a standing position. 3.) Repeat with opposite leg.
  • Child's pose - 1.) Sit on your knees, with your knees spread outward. 2.) Bring your upper body between your knees with your arms stretched out as far as you can go. 3.) Hold it for 20 seconds then sit back up.

Strengthening exercises:

  • Side-lying hip abductor exercise- 1. Lie on your side with the injured leg on top. 2. Both legs should be straight, then slowly raise injured leg up. 3.) Slowly bring your leg back down. 4.) Repeat steps 1-3 ten or more times.
  • Clam Shells- 1.) Lie on your side, with your knees bent inward. 2.) Move your top leg up slowly. 3.) Lower your leg back down. 4.) Repeat 10+ times then switch legs.
  • Single leg bridge- 1.) Lie on your back. 2.) Place your feet flat on the ground, where your legs is bent at a 90 degree angle. 3.) Straighten your right leg, and raise it off the ground. 4.) Raise your bottom off the ground and hold the position for 15+ seconds with your right leg still raised off the ground. 5.) Lower your bottom to the ground and repeat with left leg.
  • Pelvic Drop Exercise- 1. Stand on a stool with the foot of the uninjured side on the stool, and the injured side hanging off the stool with the toes of your foot pointed upwards. 2.) Slowly lower your body down bending at the knees, until the heel of your foot touches the ground. 3.) Slowly straighten your leg to go back up. 4.) After repeating 10+ times, switch to where your injured leg is on the stool and repeat steps one through three.

Lunge Matrix (five different lunges)

  • Front Cross Over Lunge- 1.) Keep your left foot planted firmly on the ground. 2.) Bring your right foot forward and position it in front of your left foot. 3.) Your right leg should be bent at a 90 degree angle. 4.) Repeat with opposite leg.
  • Rotational Lunge- 1.) Standing with both feet planted side by side on the ground. Step forward with your right leg, with the knee bent at a 90 degree angle. 2.) Twist your upper body towards the right side (left elbow lined up with your right knee). 3.) Hold for a couple of seconds than twist back, and go back to the standing position. 4.) Repeat with opposite leg.
  • Backward Lunge- 1.) Keep one foot on the ground. 2.) Bring your right foot behind you, bending it at a 90 degree angle. The front leg should be straight. 3.) Hold for a few seconds then repeat with opposite leg.
  • Rotational Backward Lunge- 1.) Standing with both feet planted side by side on the ground. Step backward with your right leg, with the knee bent at a 90 degree angle. Left leg should stay straight. 2.) Twist your upper body towards the right side (left elbow lined up with your right knee). 3.) Hold for a couple of seconds than twist back, and go back to the standing position. 4.) Repeat with opposite leg.
  • Lateral Lunge- 1.) Stand with both feet planted side by side. 2.) Take your right foot and step outward towards the right, bending your knee. 3.) Hold for a couple of seconds then bring your right foot back to the left, then repeat with the opposite leg.

Back to Top

book an appointment today
(or check your pains / injuries)

Phoenix Rehab Physio Services

Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.


Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, usually will benefit / require Hand Therapy to

  1. manage and decrease hand pains
  2. improve range of motion, strength and dexterity
  3. increase the function of their hand following injuries or post-operations

Commonly treated hand pain injuries includes


Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing.

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.


  • Cupping TCM
  • Auricular Therapy TCM
  • Herbal TCM Medicine & Supplementation


Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to accelerate recovery and  shorten downtime / recovery period required.

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance. Having regular deep tissue and sports massage will keep your muscles healthy and fit with body/movement-confidence.

Read the benefits of regular deep tissue release therapy here.


All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

do Tell Your Family, Friends And Colleagues About Us =)

We appreciate you as our valued clients and want you to know that the # 1 way we grow as a clinic / brand is through word of mouth referrals from valued patients like yourself.

We prefer not to rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.

book an appointment today
(or check your pains / injuries)

Recent Articles

  1. Adele Ang Principal Physiotherapist Singapore

    Jun 29, 22 08:32 AM

    Adele is a registered physiotherapist with over 25 years of experience including treating national athletes as well as recreational athletes having worked in Singapore Sports Council and Singapore Spo…

    Read More

  2. Achilles Tendon Pain Physiotherapy

    Feb 03, 22 04:05 AM

    Achilles tendon pain is very common among recreational and elite sportspeople. But it is also common among sedentary individuals

    Read More

  3. Tendonitis Physiotherapy & Hand Therapy

    Feb 03, 22 12:16 AM

    Tendonitis, tendinopathy and tendinosis are all tendon injuries and treated by physiotherapists and hand therapists

    Read More

  4. Cervical Spondylosis Physiotherapy

    Jan 11, 22 02:01 AM

    Cervical spondylosis is a general term to describe the degenerative condition in the neck which results in pain and other symptoms

    Read More

  5. Tendon Pain Tendinopathy Physiotherapy

    Jan 07, 22 12:28 AM

    Tendinopathy (tendon injuries) can develop in any tendon of the body and has many names such as tendinitis and it can be treated with good tendon physiotherapy

    Read More

  6. The importance of staging and compression in tendinopathy physio

    Dec 15, 21 01:47 AM

    Tendon problems are common in runners and can become a persistent issue if not properly treated.

    Read More

  7. Tendon Pain Physiotherapy and Hand Therapy

    Dec 14, 21 11:23 PM

    Pain and pathology in a tendon, known as tendinopathy, is a common injury in athletes that can be difficult to manage. Physio and hand therapy can help healing

    Read More

  8. Tendon Injuries Physiotherapy, Hand Therapy, TCM & Massage

    Dec 07, 21 01:31 AM

    We use the world’s best tendon recovery programs through cutting edge treatment techniques for all tendon injuries (and tendon injuries differ accordingly)

    Read More

  9. Physiotherapy and Hand Therapy at Tampines Singapore

    Nov 28, 21 12:08 AM

    Phoenix Rehab Physiotherapy and Hand Therapy at Tampines Singapore

    Read More

  10. Mallet Finger Tendon Injury Rupture Hand Therapy

    Nov 17, 21 12:30 AM

    Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb.

    Read More