What are the common symptoms of ITB Syndrome?

The main sign is sharp pain on the external area of the knee that can radiate to the outer thigh or calf. It is often worsened by activities like running or going down stairs.

How does Focused Shockwave Therapy help ITB friction?

We utilise Focused Shockwave (FSWT) to target localized points of maximum compression at the knee with deep precision. It helps inhibit pain sensors (nociceptors) and promotes soft tissue healing where manual therapy may be limited.

Can I use Bupa or AXA insurance for ITB treatment at Bodytonic?

Yes, our clinics in Canada Water and Stratford accept major health insurers including Bupa, AXA Health, Aviva, and Vitality for the treatment of ITB Syndrome and related knee injuries.

Ilio-tibial band (ITB) syndrome

Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director

Medically Reviewed: Yannick Gracia, M.Ost GOsC 10475. Registered Lead Osteopath

What is Iliotibial band syndrome?

Iliotibial band syndrome is one of the most common causes of lateral knee pain, which is usually the result of a non-traumatic overuse injury. Iliotibial band syndrome pain is commonly associated with tenderness on palpation of the lateral femoral epicondyle, that is located to the external aspect of the knee. It seems to be caused by a compression of the inferior (bottom) part of the iliotibial band itself.

The iliotibial band is a thick fibrous band of connective tissue that runs to the outside of the thigh from the iliac crest on the pelvis to the knee. It originates from the muscles tensor fasciae latae and gluteus maximus and inserts at the lateral tibial area (outside of the knee joint). It does not have any bony attachments; this allows the IT band to move freely and potentially be “pinched” or compressed when the knee moves through flexion and extension.

What are the signs of Iliotibial band syndrome?

The main presentation of ITB syndrome is a sharp pain to the external area of the knee, that can radiate to the outer area of the thigh or the calf. A tenderness to the lateral knee is frequently detected and the patient can experience an acute burning feeling if pressure is applied to the area. Pain is usually worsened by activities involving knee flexion and extension. Running or going down stairs usually exacerbates the pain.

What are the common causes of Iliotibial band syndrome?

The cause of ITB syndrome is usually multifactorial, even though the repetitive compression of the ITB tissue is the primary reason for its onset.

Our clinical team is highly specialised in these biomechanical stressors, having performed 8,000 specialised musculoskeletal treatments in 2025 alone across our London clinics.

Repetitive Compression: ITB syndrome is often triggered by repetitively bending the knee during physical activities such as running, climbing, and cycling. In fact, ITB friction is one of the 10 most common cycling injuries we treat, often caused by incorrect saddle height or poor cleat alignment.
Muscular Weakness: Weakness of the hip abductors (specifically the Gluteus Maximus and Medius) can increase hip internal rotation and knee adduction, consequently increasing the stress at the ITB insertion point.
Volume Spikes: Sudden increases in physical activities involving the knee without adequate recovery.
Pelvic Alignment: Functional leg-length discrepancies or pelvic “torsion” can alter the tension of the band. A Chiropractor or Osteopath can assess whether your hip alignment is the root cause of the knee friction.

How is Iliotibial band syndrome diagnosed?

A detailed physical examination and medical history are excellent tools for diagnosis. In some instances, a GP might prescribe an X-ray or MRI to rule out conditions like meniscus tears or lateral compartment osteoarthritis. Our practitioners use clinical testing to differentiate ITB syndrome from other potential causes of lateral knee pain.

What are the treatment options?

Immediate Precautions

The first precaution to take in order to not aggravate the symptoms when there is an acute inflammation of the ITB is to decrease the activity provoking the pain (e.g. running). Active resting should be promoted; this means avoiding activities that overload the knee but remaining active with less stressful movements (e.g. swimming). Icing the involved area may help to decrease the inflammation and then consequently the pressure on the knee. General stretching of the thigh (not just the iliotibial band) might also help to manage the pain.

Clinical Management

It is recommended to manage ITB syndrome with a chiropractor, osteopath, or physiotherapist. Our team will:

Hands-on Treatment: Use myofascial release techniques to release tension on the ITB and compensatory muscle adaptations.
Tailored Exercises: Strengthen and stretch the thigh and hip muscles to stabilise the joint.
Biomechanical Advice: Provide guidance on postural habits and activity modification to help you recover faster and assist with injury prevention.

Advanced Technology: Shockwave Therapy

If inflammation persists, Shockwave Therapy is a highly recommended non-invasive modality because it inhibits nociceptors and promotes soft tissue healing. NICE IPG311 guidelines for Shockwave.

We utilize:

Radial Shockwave (ESWT): To release broad fascial tension across the thigh.
Focused Shockwave (FSWT): To target localised points of maximum compression at the knee or hip with deep precision.

Rare Interventions

In rare cases, when prolonged conservative management has not been effective in alleviating the pain, surgery might be indicated. However, it must be noted that surgery is not considered a first form of intervention for managing ITB syndrome.

How long does Iliotibial band syndrome last?

When treated, ITB syndrome can take from a few weeks to months to completely heal. The more you rest the faster you recover. However, it is important to work on the causative factors otherwise there might be a risk of relapse as soon as you go back to your normal routine.

Can Iliotibial band syndrome be prevented?

Not all causes of ITB syndrome can be prevented. However there are a few things that you can do to keep your knee joints healthy:

What are the best exercises for Iliotibial band syndrome*?

Muscles which stabilise the hips seem to have a key role in avoiding overloading the ITB. In particular, glute or hip abductor weakness can contribute to the onset of ITB syndrome. In light of this, the following exercises might be very effecting in ITB syndrome management and treatment:

Side-lying hip abduction. Lie down on the floor on your side resting your head on your arm. Hips and shoulders should be aligned vertically to the floor and your head should be aligned with the spine. Raise the top leg off the lower leg while keeping the knee extended and the foot in a neutral position. Lift the leg up until the hip starts tilting upwards or until you feel tension developing to the lower back or to the oblique muscle. Then gradually return to the neutral position. Repeat it 10 times, then switch legs.
Single-leg wall squat. Start by positioning yourself with the back flat against the wall. Walk the feet a few steps forwards, keeping your back against the wall. Legs should be overall straight, with the knee slightly bent, and the feet hip-width apart and parallel. Lift the right leg and extend it in front of you, while bending the left knee and squatting down until the left thigh is parallel to the floor. Keep the right leg lifted and extended during the execution of the exercise, as well as the back pressing backwards to the wall. Pause for 3 second and then come back to the starting position. Repeat for 10 times, then switch legs.
Single-leg deadlift. Start standing with your feet hip-width apart and parallel. Hold a weight, kettlebell or barbell in your hands in front of you. Lean forward with your chest and shift the weight to one leg, while you start extending the other one straight behind you. Lift the back leg while you move your upper body forward until you form a ‘T’ shape. Arms remain straight down, holding the weight. Keep this position for 5 second, then gradually come back to the neutral position. Repeat 10 times for each leg.

*It is recommended to get the go ahead from your chiropractor, osteopath, physiotherapist or GP before trying out any of these exercises.

It is important to remember that a specific individualised plan based on a physical assessment with a professional therapist might be more effective on finding the causative factors and addressing the needs for your body and symptoms.

Do I need to see my GP for Iliotibial band syndrome?

Iliotibial syndrome is not an emergency that needs urgent GP intervention. You might try first to rest, carry out some self care adise (e.g. icing, stretching) and exercises. If improvements are not witnessed, your GP might suggest a referral for some physical therapy to better address the syndrome and manage the biomechanical abnormalities that might still persist.