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Iliotibial Band Pain Physiotherapy

Iliotibial Band Syndrome (ITBS), aka Iliotibial Band Friction Syndrome (ITBFS), is a very common thigh injury known to runners, cyclists and hikers. It usually presents clinically as a stinging pain at the side or length of the affected knee and hip.

Its name is from the ilotibial band (see the picture) rubbing against the bony bump at the side of your knee or hip. How that happens is that the iliotibial band is a very thick band of fibrous tissue that starts from our largest hip muscles and goes along the outer side of or thighs and inserts into the tibial bone below the knee.

So before it inserts into the knee, it "runs" over a bony protusion at the thigh bone (this is the lateral femoral epicondyle"), and when this happens repeatedly over time usually due to repeated bending and straigthening of the knee, this leads to a localized inflammation at the ITB.

Unfortunately, as the iliotibial band is also part muscle, it can be very tight too especially if you

  • swim
  • run
  • cycle

very regularly...and the more regular or intense your trainings, the more it'd cause your ITB to rub over the bony protusion, and it'd cause more painful inflammation in turn.

Please note that iliotibial band pain syndrome is not just for the runners, hikers, swimmers or cyclists - unfortunately it may/can affect anyone who increases their activity or sports too fast too intense...and so we see such cases quite often in our physio clinics.

risk factors

Increased risk factors of iliotibial band pain syndrome includes

  • abnormal walking patterns such as overpronation of the feet (where the feet goes inwards because of collapsed arch or habit)
  • leg length discrepancies
  • bow-legged syndrome

The most vulnerable range of knee flexion that starts and perpetuates this condition is when the knees are flexed at 30 – 40 degrees – this is where the ITB crosses most frictionally over the lateral femoral condyle (that's why cyclists and runners are most often at risk for this condition unfortunately).

What causes tightening of the Iliotibial Band?

There are a total of THREE (3) things that causes and/or aggravates tightness to the ITB, and they are: 

  1. Improper training/training methods
  2. Improper walking patterns
  3. Weakness of the outer thigh muscles 

Improper Training/Training Methods 

When runners or hikers train improperly, such as

  • increasing intensity too fast (eg sudden spike in speed or distance training without gradual training); or
  • training over non-recommended/inappropriate surfaces such as uneven, banked surfaces or downhill running

– all these increases strain over the ITB. Also, avid cyclists who prefers to point their toes inwards instead of aligning their toes in a neutral forwards-facing pulls the ITB to more length, causing it to work harder along the extended length, aggravating the tightening the ITB.

Improper Walking Patterns

  • Foot structures that have arches that are too high or too low 
  • leg length discrepancies (uneven leg length)

always causes the ITB to tighten on one side, because one side is worked harder than the other, causing direct imbalance, leading to compensation and overworking.

For cases such as this, physiotherapy biomechanical assessment on your walking pattern will identify and pinpoint the problem and we can improve on patients muscles and joints.

Where it is appropriate, our senior physiotherapists may prescribe supporting foot orthotics such as full or semi-customized insoles to correct or minimise these problems.

Weakness Of The Outer Hip Muscles

Weakness of our outer hip muscles causes our iliotibial band to overwork to compensate for it. This increases ITB tightness and gradually becoming an Iliotibial Band Friction Syndrome.

A combination of regular deep tissue massage and myofascial release to loosen ITBs, stretching and strengthening the weak outer hip muscles will help to diffuse the load across to ensure that our iliotibial bands don’t overwork or compensate.

iliotibial band pain summary

Athletes who has high training hours, volume and intensity always have painful iliotibial bands simply because of their high intensity training.

In such situations, regular deep tissue release and massage with our senior sports massage and deep tissue release therapist will help to release your tight iliotibial band (see who your therapist will be), and keep it at optimal length for best sports and training performance.

Do stretch your ITB after every session of exercise and training or games. In fact, especially if you are a seated worker too - untreated tight ITB can cause low back pain as well.

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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.


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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.



Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to

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It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance.

Done regularly, it will keeps 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.

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book your physio appointments now

WhatsApp / SMS your name, preferred date, time and enquiries to +658800183

Email questions and your preferred physiotherapy timings to nigel@phoenixrehabgroup.com or

Clinic Locations: See how to get to us here