Understanding ITB Syndrome: How Osteopathy Can Help

Written by By Dr Felix Adamson-Walter (Osteopath) 

Iliotibial Band Syndrome (ITBS) is one of the most common causes of pain on the outside of the knee in runners. It usually presents as a sharp or burning pain on the lateral side of the knee that often worsens with running, especially downhill or over longer distances.

ITBS develops when the iliotibial band, a thick band of tissue running down the outside of the thigh, becomes irritated as it rubs over the structures at the knee. While many people assume this is only a problem with the ITB itself, in reality it is usually the result of poor mechanics further up or down the chain.

Common contributing factors include:

• Sudden increases in training distance or intensity

  
  

• Weakness or poor control of the gluteus medius and other hip stabilisers

  
  

• Reduced ankle and foot function leading to altered loading patterns

  
  

• Poor coordination between the foot and hip, creating increased strain at the knee

  
  

• Running on cambered roads or uneven surfaces

  
  

• Worn-out or poorly supportive footwear

  
  

• Excessive weekly running volume without adequate recovery

Treatment

As an Osteopath, I focus on understanding how your whole body is moving, particularly the conversation between your foot and hip. If your ankle or foot is not absorbing and directing load properly, the hip often struggles to stabilise the leg. This mismatch frequently ends up overloading the ITB and irritating the outside of the knee.

Treatment can include hands-on techniques to release tension in the ITB, quads, and glutes, as well as joint mobilisation to restore ankle and hip movement. In conjunction with treatment, corrective exercises are used to build foot control, hip stability, and coordination between them. This is combined with guidance on managing your training load so you can reduce irritation while continuing to stay active.

Some helpful tools I use with my patients are:

Relative Rest: Swap out painful runs for cycling, swimming, or pool running while symptoms calm down.

Strengthening: Focus on glute medius, glute max, and foot intrinsic muscles. Single-leg balance and control work is especially effective. Then progressing into targeted strength and conditioning and plyometrics

Mobility Work: Stretch and mobilise the hip flexors, quads, and calves. Foam rolling of the ITB and surrounding muscles can help with symptom relief.

Foot and Ankle Function: Restore mobility where restricted and build strength where weak to improve load transfer through the lower limb.

Load Management: Avoid sudden spikes in mileage, speed, or hill sessions. Build gradually and include recovery weeks.

Holistic Wellbeing: Adequate sleep, nutrition, and hydration remain essential for tissue repair and recovery.

Prevention

Prevention is about maintaining balanced strength and control throughout the lower limb. To reduce your risk of ITBS:

• Progress training volume gradually, following the 10 percent rule

  
  

• Strengthen your hips and feet as part of your regular program

  
  

• Include single-leg exercises and stability work

  
  

• Vary running surfaces where possible

  
  

• Replace running shoes every 500–700 kilometres

  
  

• Listen to your body and act early if pain begins

ITB Syndrome can be frustrating and often lingers if the root causes are not addressed. With early treatment and a comprehensive approach that looks beyond the knee, most people can recover fully and return to pain-free running. Restoring the connection between the foot and hip is often the missing piece to long-term success.

If you need some extra support to get back to running pain-free, book an appointment with Felix, below. Alternatively, give us a call on 0425 876 929 to discuss your needs.

Book an Appointment

References

Beals, C., & Flanigan, D. (2013). A review of treatments for iliotibial band syndrome in the athletic population. Orthopedic Journal of Sports Medicine, 1(4), 2325967113506815.

Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., & Benjamin, M. (2015). Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport, 18(4), 496–500.

Lavine, R. (2010). Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine, 3(1–4), 18–22.

Muchna, A., & Gallo, R. A. (2020). Diagnosis and management of iliotibial band syndrome: A critical review. Sports Health, 12(6), 534–540. https://doi.org/10.1177/1941738120945308

van der Worp, M. P., van der Horst, N., de Wijer, A., Backx, F. J. G., & Nijhuis-van der Sanden, M. W. G. (2012). Iliotibial band syndrome in runners: A systematic review. Sports Medicine, 42(11), 969–992. https://doi.org/10.2165/11635400-000000000-00000