ITB syndrome, also called runner's knee, really caused by friction and by a tight ITB? Should we stretch and foam roll or is it about glute training?First of all, ITB syndrome is certainly the most common cause of pain in the lateral knee, with a reported incidence of up to 12% of all running-related overuse injuries. There are certainly other causes of lateral knee pain as well. Typical signs and symptoms for ITB syndrome are worse pain when running downhill or on narrow trails and a spike in history of training volume.

Originally, the idea behind ITB syndrome was that the ITB shoots across the lateral epicondyle of the femur. This would happen around 30 degrees of flexion when the ITB changes its force direction from an extension force on the knee to a flexion force or vice versa. But what then is ITBS? The authors reason that during knee flexion, the ligament moves medially due to internal rotation of the tibia, which presses the fat pad under the ITB against the epicondyle. Upon extension, the ITB moves laterally again. Excessive compression of the fat pad can trigger an inflammatory response that could be pain generator in ITBS.

So how do we treat ITBS? The general recommendation is to strengthen the gluteal muscles to reduce hip adduction and thus reduce tension on the ITB.This depends greatly on the patient: While there are patients with elevated valgus who can certainly benefit from hip strengthening, the second group exhibiting ITBS are usually men with knee valgus.For runners, it ultimately comes down to a mix of addressing the biomechanics of running, addressing training errors and neuromuscular deficits.