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By Chris Nentarz Physical Therapy Manager at Athletes’ Performance

Physical therapist Chris Nentarz talks on “Iliotibial Band Syndrome” (ITBS) and the ways you can prevent this common running injury. Chris Nentarz is Physical Therapy Manager at Athletes’ Performance ( He is a Physical Therapist, Certified Strength Training Specialist and Performance Enhancement Specialist with over eight years of experience working with athletes of all levels, including providing consultation services to numerous professional and elite organizations in the United States and Canada.

With many of you training for running events this year, we wanted to share this article from physical therapist Chris Nentarz on common injuries that plague runners, and what you can do to avoid them. (Hint: it involves the TRX Suspension Trainer.) The majority of running injuries are results of overloading, under recovery, poor biomechanics and related movement pattern dysfunctions. Rehabilitation and performance methods for runners should take all these factors into account. “Iliotibial Band Syndrome” (ITBS) is one of the most common injuries documented in runners. This two-part article is meant to shed light on some of the true causes of ITBS and give relevant solutions to address these causes.

The Need

ITBS can be a challenging injury to overcome, many times requiring four to six weeks to recover. Many bouts of ITBS return only weeks or months later. Traditional treatment many times fail because they spend too much time focusing on or around the local pain site. As you will learn, the wisdom of resolving ITBS can be found by treating the source of the dysfunction and not the local painful tissue. ITBS occurs due to a small imbalance in our system. A great analogy is a car. If your tire alignment is off, then we will have early and excessive wear and tear on our tires. So I ask, “What good is it to replace the tires if we don’t address the systems alignment?” We have all fallen victim to this paradigm termed “eductionism.” The tires are not to blame in the car’s altered performance.

What is the Iliotibial Band?

The Iliotibial Band (ITB) is a thick fibrous tendon that extends from the outside of the pelvis down to the outside of the knee and shinbone. The ITB adds stability to the lower leg and functions to decelerate the internal rotational forces created as we impact the ground during running. In many cases, the ITB is wrongfully blamed for knee pain.

What Goes Wrong?

Classic symptoms of ITBS include pain along the outside of the knee that may be accompanied by a clicking sensation. A popular theory states that problems occur when the joint flexes and extends during running and friction is created between the ITB and outside of the knee. This theory shouldn’t be discounted but our experience and biomechanical understanding tells us that there are many more factors causing the injury. As with any injury, our bodies will be influenced by factors including overloading, under recovery, poor biomechanics and movement pattern dysfunctions.


Most running injuries, including ITBS, are a factor of overloading the body’s physiology. As runners, we are prone to overuse injuries for two primary reasons. First, let’s face it: we enjoy running. Sometimes we ignore our bodies signs of “too much,” “too far” and “too long.” It’s good to go the extra mile, just don’t do it everyday. Dose your runs with intention. Secondly, running is a repetitive movement by nature. Even the most perfect system when exposed to the same stresses over and over again, will breakdown over time. Add variability to your running routine by changing speeds, surfaces and distances. In adjunct, lower the risk of overuse injuries by complimenting your running with a functional strength training program that consists of sport specific core stability exercises and stability-based movements.

Under Recover

Having a balance between work and rest will breed success. Recovery, or regeneration, should be an active process. It should be a lifestyle philosophy, incorporated into all areas of our lives. Recovery steps should be done daily, best implemented after training in the form of foam rolling, stretching, and cold baths. In addition, we should schedule regeneration days into our programs that may include yoga sessions, body work or other measures you find add balance to your life. The better you recover, the quicker the body will adapt.

Foam rolling is a must for any runner. It is important to focus your time and energy on the most important regions. Most people spend time rolling the ITB. While this may seem effective, superior results can be obtained by performing self-tissue work on your Tensor Fascia Latae (TFL), not your ITB. The TFL is the contractile element of the ITB and is popularly left out of self-massage routines. This can be done at the gym, on the trail or when watching TV.

Poor Biomechanics

Would you start golf without some type of instruction? Probably not. Yet, the majority of us have never educated ourselves prior to starting the sport we enjoy most. I recommend enjoying one of the numerous running methods taught these days, including Chi, Pose or my favorite, Natural Running. They all have merits, so do some research to find out which one fits you most. Lastly, spend time with a running coach, as they will be able to give you subtle form tips and drills that will help you become a more efficient and powerful runner. Listen to Danny Abshire, world famous running coach, discuss running form here:

Movement Pattern Dysfunctions
Movement pattern dysfunctions (MPDs) are imbalances in how our bodies move. They can be small or large. When someone limps, they are adapting MPDs to avoid further injury of damaged tissues, while simultaneously allowing the body to move. MPDs are subconscious and allow us to fight or flight when injured. MPDs are caused by a combination of muscle imbalances, joint restrictions, poor stability or previous injury. In Iliotibial band syndrome there may be multiple biomechanical imbalances at play. The most common involve the ankle and hip joints.

Below the knee at the foot, excessive internal rotation forces can overload the ITB. These abnormal loads are usually created due to excessive heel striking, tightness in the gastrosoleous complex, and stiffness in the ankle mortise. Above the knee, weakness or early fatigue of our glutes can again cause the ITB to work overtime to decelerate and accelerate the forces that act on our bodies during running. Performing a well designed and executed corrective exercises will restore and maintain the movement quality of your joints. This ultimately will reduce MPD’s and allow the body’s natural healing processes to function optimally.

Initial Treatment

The ultimate goal in your rehab should be to resolve the underlying cause of the problem; however, it is important to address acute symptoms immediately. Your initial treatment should focus on:

  •  Relative Rest – Take a break from activities that cause your knee pain. Continue to train using the activities that do not increase your symptoms, such as biking, swimming and functional training.
  •  Kinesiology Tape – The application of kinesiology tape will decrease pain and allow the key muscles surround the knee to function properly. A knee spider and TFL taping can be particularly useful in ITBS.
  •  Ice – Apply ice packs three to four times a day for 10 to 15 minutes.
  •  See a sports medicine physician if symptoms don’t subside within two weeks.

Final Thoughts

We have all fallen victim to isolating painful body parts. Pain is a fantastic warning signal telling us that all is not well in the system. To effectively treat ITBS, we must address multiple factors. When considering sustained high performance, don’t fall victim to reductionism. To permanently put an end to these nasty symptoms, we must look above and below the pain site and consider the system as a whole.