Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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ITB Syndrome Physical Therapy Guide

What is ITB Syndrome?

The ITB is a thick fibrous band that runs from the iliac crest via the glutes, down the outside of the leg and across the knee joint, connecting to the outside of the patella on it’s route. It crosses both the hip and the knee joint and has a role in stabilising both.The longstanding theory is that the IT band runs over the femoral condyle as the knee bends creating friction, inflammation and pain. Recent literature has challenged this view saying there is a highly innervated layer of fat between the femoral condyle and the ITB and it is this that becomes inflamed and painful. Either way the result is pain, usually felt on the outside of the knee and around the IT Band.


  • Pain localised to the outer knee or hip
  • Snapping or popping sound at the knee or hip.
  • Swelling
  • Commences when running

What Causes It?

There are multiple causes of Iliotibial Band Syndrome (ITBS), here are the main 3!

  1. Changes in training: The most common cause of ITB syndrome is due to a sudden adaptation in training or increase in running mileage, which places a further stress on the legs that they aren’t capable of dealing with. The high load on the ITB causes inflammation and pain. Of course mileage isn’t the only variable, it might be an increase in speed, or hill work, a change of running surface or how you space your runs out over the week.
  2. Muscle weakness: In ITB Syndrome the culprit is often the Gluteus muscle group, most commonly the Gluteus Medius. Gluteus Medius abducts the hip, taking the leg away from the body, and the anterior fibres are thought to internally rotate the hip and the posterior fibres externally rotate. If GM is weak or isn’t kicking in quickly enough then another muscle, Tensor Fascia Latae (TFL) often becomes more active to compensate. As TFL attaches to the ITB this can place greater tension on the ITB and contribute to the problem.
  3. Tissue Flexibility: Reduced tissue flexibility in the hip and adjacent structures commonly leads to the onset of ITB syndrome. The key areas are hip flexors and quads, Glutes and the ITB itself. In addition anything that affects movement of the knee can have an effect e.g. Calf and hamstring tightness. There is some debate as to whether you can even stretch the ITB! It’s such a tough, broad band some people say you can’t increase it’s length. That said stretches do seem to work for people but it may be that it’s actually Glutes that are stretched.

Treatment Options

So many treatments aim at symptom relief for the ITB but to get rid of an ITB issue long term you need to examine the cause and deal with that. It isn’t just tightness of the ITB that’s an issue, it’s also the load and stress on the ITB and the frequency at which it finds itself under load. For example a sprinter may have a really tight ITB, but only runs for 10-20 seconds in a race exposing the ITB to high loads but only briefly. A marathon runner with a slightly tight ITB will be running for upwards of 3 hours (obviously depending on level) so while the load might be lower on the ITB it is exposed to it for far longer. To compensate for this, we need to focus heavily on improving the strength, length and load management of the gluten and other hip muscles.


Exercise is the most important component for your recovery and one that must not be avoided.

Tensile load needs to be placed through the affected muscle to enable it to grow! In this case we are focusing on strengthening and the glutes, quads and ITB band!

These exercises should be done daily; they will take approximately 20 minutes, but will greatly improve your pain, prognosis and recovery time.

ITB Syndrome Exercises

1) Crab Walks

This is a fantastic exercise prescribed by Physical Therapists and personal trainers that will make your glutes and quads burn! (in a good way). It places a great deal tensile load through the the hip muscles and strengthens them very quickly.

How to do it:

  • Tie your theraband into a loop or use a loop band! Step into the loop so that it is wrapped around your ankles.
  • Stand hip width apart and sit into a squatted position.
  • Slowly step side to side like a crab whilst maintaining a good squat position (5 steps each direction)
  • Try and step as slowly as possible to really activate the hip stabiliser muscles.

Repeat 5 lengths, 3 sets. Try to do this 3 times per day.

2) Waltz Walks

Similar to the crab walks, the waltz walks are basically a functional lunge on steroids. The exercise once again places great load through your hip muscles and are fantastic for overall strengthening and injury prevention!

How to do it:

  • Tie your theraband into a loop or use a loop band! Step into the loop so that it is wrapped around your ankles.
  • Stand hip width apart and slightly sit into a squatted position.
  • Slowly step forward, and to the side to side like you were performing a waltz whilst maintaining a good squat position (5 steps back and forth).
  • Try and step as slowly as possible to really activate the hip stabiliser muscles.

3) Lateral Raises

Also known as hip abduction, lateral raises activate your Glute Medius and ITB and are a fantastic exercise for general hip strengthening.

How to do it:

  • Lie on your side (on the hip you aren’t exercising) with your head supported and knees straight.
  • Slowly raise your upper leg towards the ceiling.
  • Try to maintain your pelvis position.
  • To progress the exercise, hold the leg in its upmost position for 10 seconds before slowly bringing it back down.

Repeat 10 times, 3 sets. Try to do this 3 times per day.

4) Hip thrusts

Hip thrusts are certainly our favourite bottom strengthening exercise, and are becoming the “go-to” exercise for personal trainers trying to help their female clients gain mass in that area!

How to do it:

  • Sit on the ground with a bench or something sturdy behind you. Lean back onto the bench so that your shoulder blades are resting near the top of it.
  • Have a weight or barbell resting on your lap.
  • Drive through your feet, extend your hips and push the weight towards the ceiling, hold at its upmost position for a few seconds if possible, squeezing your bottom in the process.

Repeat 10 times, 3 sets. Try to do this 3 times per day.

5) Clams

Similar to the lateral hip raise exercise, the Clam is used to strengthen the Glute Medius and in-turn, the painful ITB. To make this harder and really activate the muscle group, add resistance in the form of a theraband

How to do it:

  • Lie on your side (on the hip you aren’t exercising) with your head supported and your hips bent to 45º and knees bent to 90º. Keep your ankles and knees together at all times.
  • Wrap a theraband around your knees and tie it together, it shouldn’t be loose!
  • Slowly tense your bottom and core muscles, and bring your upper knee towards the ceiling.
  • Very slowly bring the knee back towards the floor.

Repeat 10 times, 3 sets. Try to do this 3 times per day.

6) Frogs

A modified squat that really gets the quads burning and is fantastic for strengthening and cardio! It can be a bit complicated so check out this youtube video if you’re still confused!

How to do it:

  • Stand with your feet shoulder width apart.
  • Complete a full squat, bottom close to the floor.
  • Link your hands and move your bottom towards the ceiling, straightening your hips and knees, before going back into your full squat position.
  • Repeat for 30 second periods.

Repeat 10 times, 3 sets.

7) ITB Stretch

It is close to impossible to stretch the ITB due to its anatomical location, but this exercise is the best of the bunch.

How to do it:

  • Stand upright facing a counter or worktop that you can rest on.
  • Cross your injured leg behind the other leg.
  • Lean slowly towards the opposite of the injured side with your upper body until you feel a stretch down your injured hip.
  • Hold stretch for 15 seconds.

Repeat 5 times throughout the day.

Deep Massage & Foam Rolling

 Deep transverse frictions are a fancy way of saying “foam rolling” and are a basic treatment to speed up the recovery process tendon injuries like ITB syndrome, which is used by Physical Therapists, but can be performed by the patients themselves using a decent foam roller. The purpose of deep friction massage is to maintain the mobility within the soft tissue structures of the tendons and prevent adherent scars forming. The massage is deep and must be applied transversely to the specific tissue involved (The Ilio Tibial Band). The movement encourages realignment and lengthening of these wrist extensor muscle fibres and will improve your recovery rate.

Many professionals find it preferable to use foam rollers or Muscle Stick rollers, which can be found here!

Taping And Strapping

There are some great advantages to strapping up the elbow. Rest is an important part of the recovery process and slightly immobilising the painful structures with a strap is certainly an advantage to allow better healing times.When performing any activities that put the knee at risk, a strap could be seen to help avoid re-injury by giving proprioceptive feedback to your tendon. Check out our favourite tape here!


Left untreated, ITBS can last anywhere between 3 months and 2 years, and you have a high chance of the condition returning if you do not adequately complete your rehabilitation programme! Research suggests that it is a combination of rest, exercise and gradual return to sport are the most effective way of treating the condition, a high majority of patients show significant improvement after 6 weeks of treatment, however it can take much longer.

To reduce your chances of getting ITBS again, you must continue to strengthen and stretch your glutes, quads and hamstrings. Taking breaks from activities that involve long periods of tendon loading will also prevent tendon micro-trauma and if you feel some pain coming on, you must try and cease that activity immediately.