1. Introduction / Plain Theory

Iliotibial Band Syndrome (ITBS) is an overuse injury affecting the outer (lateral) side of the knee, caused by friction or compression between the iliotibial band (ITB) and the underlying tissues near the lateral femoral epicondyle.

The ITB is a thick band of fascia extending from the tensor fasciae latae (TFL) and gluteus maximus at the hip down to the tibia.
It plays a crucial role in stabilising the knee during movement, particularly in single-leg stance activities such as running or cycling.

When repetitive flexion and extension of the knee occur with poor movement control or excessive tension in the ITB, it can cause localized irritation, inflammation, or pain over the outer knee.
ITBS is the most common cause of lateral knee pain in runners, accounting for up to 12% of all running-related injuries.

2. Typical Symptoms and Functional Impact

• Sharp or burning pain on the outer side of the knee, often appearing during or after running.

• Pain that worsens when running downhill or after long distances.

• Tenderness over the lateral femoral epicondyle (just above the knee).

• Occasional snapping sensation as the knee bends and straightens.

• Discomfort during prolonged sitting or cycling.

Functional impact:
ITBS can significantly limit running and other endurance activities.
If untreated, pain may spread upward along the thigh or lead to compensatory strain in the hips and lower back.

Red flags:
Persistent swelling, locking, or instability should be assessed for meniscal or ligamentous injury.

3. Contributing Factors / Underlying Causes

ITBS develops when repetitive movement and poor load control create excessive tension in the ITB and surrounding structures.
Common contributing factors include:

• Weak gluteal muscles, especially gluteus medius, leading to poor hip stability.

• Tight TFL and ITB, increasing lateral knee compression.

• Overpronation of the foot or poor footwear.

• Pelvic or lumbar asymmetry, altering load distribution.

• Training errors — sudden increase in running distance, intensity, or terrain changes.

• Running on sloped surfaces (roadsides) causing uneven hip loading.

• Poor bike setup in cyclists.

From an osteopathic perspective, ITBS is not simply a “tight band” problem.
It reflects fascial and biomechanical imbalance involving the pelvis, hip, and knee — a product of inefficient load transfer along the kinetic chain.

4. Osteopathic Approach

Osteopathic treatment aims to reduce fascial tension, optimise movement, and restore load balance through the entire lower limb.

An osteopathic assessment may include:

• Observation of gait, pelvic alignment, and lower-limb biomechanics.

• Palpation of fascial continuity from the TFL through the ITB to the lateral knee.

• Gentle mobilisation of the hip, knee, and pelvis to improve coordination.

• Myofascial and soft-tissue release of the gluteals, TFL, and quadriceps.

• Indirect or functional techniques to reduce irritation at the lateral knee.

• Correction of contributing factors such as foot mechanics, leg length, or pelvic rotation.

• Guidance on hip strengthening, load management, and training adaptation.

Treatment focuses on restoring balanced motion and reducing strain, not simply “stretching the IT band.”

5. Scientific Evidence & References

Current evidence supports manual therapy, hip strengthening, and load modification as effective conservative treatments for ITBS.
Studies emphasize that improving gluteal activation and pelvic control reduces recurrence and improves long-term outcomes.

Osteopathic care aligns directly with these principles — integrating local and systemic interventions to optimise tissue function and coordination.

References

1. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451–459. Link

2. Ellis R, Hing W, Reid D. Iliotibial band friction syndrome: a systematic review. Man Ther. 2007;12(3):200–208. Link

3. Baker RL, Fredericson M. Clinical biomechanics of iliotibial band syndrome in runners. Am J Sports Med. 2016;44(3):747–754. Link

4. Lavine R. Iliotibial band friction syndrome. Curr Rev Musculoskelet Med. 2010;3(1–4):18–22. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for lateral knee and hip pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Falvey ÉC, Clark RA, Franklyn-Miller A. Mechanisms of iliotibial band friction syndrome in runners: a review. Sports Med. 2010;40(8):651–665. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for lateral knee pain: network meta-analysis. Front Pain Res. 2024;15:1507502. Link