Treating ITB Syndrome | Physio and Chiropractor Penrith

Updated: Jan 13, 2020

Iliotibial band syndrome or ITB syndrome is a common irritable injury of the hip, upper leg and knee. Treatment or management techniques need to be multi-modal and will consist of settling the tissue down and then building the strength and mobility and tolerance back up. As a physiotherapis, chiropractor, and accredited exercise physiologist in Penrith, Toby utilises assessment and management techniques supported by evidence and have been proven to work. Below is an example of management strategies for ITB syndrome.


Acute phase

  • Activity modification- can continue running, cycling and swimming up to the time where pain presents. Running might consist of some low threshold intervals on a treadmill or track practicing the external cueing during these runs. Running/cycling on Wednesday and Saturday. Strength training Monday, Tuesday, Friday.

  • Use of the Game Ready ice compression machine or ice at home.

  • Topical (or oral) non steroidal anti-inflammatory medication.

  • Manual therapy: chiropractor led joint mobilisation of hip rotation, soft tissue on TFL and lateral quadriceps and hamstrings.

  • Strength training: physiotherapy led exercise lateral band walks, double leg hip thrusts, seated and standing calf raises, palof press, ab-wheel roll-outs.


Sub-acute phase

  • Progress pain free running, cycling and swimming by 10% every 5-7 days, allow 36 hours rest between loading. Running/cycling on Monday, Wednesday and Saturday. Strength training Tuesday, Thursday, Friday.

  • Gait re-training treadmill protocol (as above) 1-2 times per week using “run on a line or just outside of a line” and run quietly as external cues.

  • Use of the Game Ready ice compression machine or ice at home where necessary to manage flare ups.

  • Manual therapy: chiropractor led joint mobilisation of hip rotation, soft tissue on TFL and lateral quadriceps and hamstrings.

  • Strength training: physiotherapy led exercise with lateral band walks, cable hip abduction, single leg hip thrusts, single leg stiff leg deadlift, single leg seated and standing calf raises, palof press, ab-wheel roll-outs, side plank.

Return to sport phase

  • Progress running program to include easy sprints (40-100m) and some hill training efforts (30sec); continue to monitor load and not to increase by more then 10%, continue to rest for 36 hours between loading. Running/cycling on Monday, Wednesday, Saturday and Sunday. Strength training Tuesday, Thursday.

  • Strength training: physiotherapy led exercise with heavy, slow resistance to continue for hip extension, hip abduction, eccentric hamstrings, seated and standing plantarflexion, anti-rotational and anti-lateral flexion trunk exercises; 4 sets of 6 reps with heavy load is suitable.

Education and advice

  • Load tolerance and sufficient resting to allow tendon/fascia tissue to regenerate after loading.

  • Stretching is of no help and in some circumstances of high irritability the compression of the ITB against the femoral condyle can increase tissue irritation and pain. One article has described the ITB fascial load required to stretch and concluded that many different treatment options other than stretching have also been suggested for use to increase ITB extensibility. These include, but are not limited to, manipulative treatment techniques , self-administered myofascial release techniques utilising a foam roll, and myofascial release techniques that are manually applied by a therapist. However, any contemporary recommendation supporting the use of these approaches can only be based on clinical experience and speculative conclusions in the absence of rigorous clinical data.

At Sydney Muscle & Joint Clinic our approach is consistent, high quality and based on the best scientific knowledge. We deliver evidence-based physiotherapy, exercise physiology and chiropractic for a range of musculoskeletal conditions, which means you get an approach that is effective, safe, and efficient. Contact your local Penrith physio today.