How To Use The Foam Roller For Iliotibial Band Friction Syndrome (ITBFS)


Iliotibial band friction syndrome (ITBFS) is a very common cause of lateral (outside) knee pain in the athletic population (Strauss et al., 2011). In fact, Taunton et al. (2002) suggested that it was the second most common injury in runners. Furthermore, studies have identified ITBFS as the most common cause of lateral knee symptoms in runners, with a reported incidence ranging from 1.6% to 12% (Lavine et al., 2010; Strauss et al., 2011; Taunton et al., 2002).

However, ITBFS is not just common in runners, it is seen in many other sports. Iliotibial band friction syndrome has also been reported in:

  • Cycling
  • Rowing
  • Skiing
  • Socer
  • Basketball
  • Triathlons
  • Field Hockey

Just to name a few! (Strauss et al., 2011). So to understand this complex condition that is common in many sports, you must know about the anatomy of the area. Therefore, this article will discuss what iliotibial band friction syndrome is, the relevant anatomy and rehabilitation advice, including the most appropriate foam roller exercises for this condition.

Anatomical Contributions to Iliotibial Band Friction Syndrome

The area of the lateral (outside part) knee is real tiger country. The ITB has attachments:

  • Proximally (at the level of the hip) via fascial attachments onto the tensor fascia latae and the gluteus maximus and gluteus medius muscles
  • Distally (at the level of the knee) the ITB has attachments to the supracondylar tubercle of the femur but then continues insert on the Gerdy tubercle at the anterolateral aspect of the proximal tibia (Muhle et al., 1999). 

This means that the ITB crosses the outside of the knee. Interestingly, the position of the ITB depends on the amount of knee flexion. Between full extension and approximately 30° of flexion the ITB is anterior to the lateral femoral epicondyle. However, when in knee flexion greater than approximately 30° the ITB sits posterior to the epicondyle (Choi, 2010).

So, What Is Iliotibial Band Friction Syndrome?

Well, that is the subject of much debate in the world of sports medicine. At this stage, there are only theories! Strauss et al. (2011) have suggested that the 3 most commonly reported are:

  1. Friction of the iliotibial band (ITB) against the lateral femoral epicondyle. It is suggested that cyclic anterior-posterior motion of the ITB over the lateral femoral epicondyle during repetitive flexion and extension activities causes inflammation of the distal ITB directly over the lateral femoral condyle  (Lavine et al., 2010; Noble, 1980; West & Irrgang, 2009).
  2. Compression of the fat and connective tissue deep to the ITB. Laboratory studies of the tissue between the ITB and the lateral aspect of the femur identified highly vascularized and innervated adipose tissue, which may suggest that ITBFS is a “fascia lata compression syndrome” rather than a repetitive friction syndrome (Fairclough et al., 2006).
  3. Chronic inflammation of the ITB bursa. Inflammation of the bursa and tendon over the lateral epicondyle is consistent with high signal intensity seen on the MRI scans of patients who presented clinically with ITBS. This theory may explain why surgical bursectomy of the sub-ITB space is successful in recalcitrant cases (Hariri et al., 2009).

Risk Factors For Developing Iliotibial Band Friction Syndrome

There are a number of previously identified risk factors for developing iliotibial band syndrome.

These include:

  • Training errors – including sudden changes in intensity
  • Hill running
  • Excessive striding sometimes known as over-striding
  • Increased mileage are commonly cited contributing factors.
  • Excessive genu varum
  • Excessive internal tibial torsion
  • Flat feet, known as over-pronation
  • Hip abductor weakness – which may manifest as increased hip adduction and knee internal rotation
  • Myofascial tightnesses (Noble et al., 1980; West & Irrgang, 2009; Strauss et al., 2011)

So, what can be done about this condition?

Foam Roller Exercises for Iliotibial Band Friction Syndrome

As suggested above, there are biomechanical faults that contribute to this condition. Inevitably, this will create muscular imbalances. Thus, the most appropriate self myofascial release exercises are those that target the myofascial structures of the:

  • Iliotibial Band
  • Quadriceps – particularly Vastus Lateralis
  • Hamstrings – particularly biceps femoris
  • Tensor Fascia Latae
  • Gluteal Muscles – particularly gluteus maximus

The videos below displays all of these components.

Gluteal Release

ITB/TFL/Vastus Lateralis Release

Hamstring Release

What Size Will Be Most Useful?

Given that you are going to cover a medium sized area i.e. the calf muscle, the best foam rollers for this condition would be:

Should I Do Anything Else For Iliotibial Friction Band Syndrome?

Yes! Unfortunately, using the foam roller is only one component of the successful rehabilitation of iliotibial band friction syndrome. To fully resolve this complex problem you should also undertake:

  • Regular stretching – ITB/TFL, quadriceps, hamstring, gluteals
  • Pelvic strengthening and stability training
  • Adjust other contributing factors – including managing your exercise load, footwear, training environment, footwear
  • Be guided by your physiotherapist – who can take you through all of this including a full rehabilitation program

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Choi L: Iliotibial band friction band syndrome, in DeLee J, Drez D Jr, Miller M, eds: DeLee: DeLee and Drez’s Orthopaedic Sports Medicine, ed 3. Philadelphia, PA, Saunders Elsevier, 2010, pp 627-628.

Fairclough J, Hayashi K, Toumi H, et al: The functional anatomy of the iliotibialband during flexion and extension of the knee: Implications for understanding iliotibial band syndrome. J Anat 2006; 208(3):309-316.

Hariri S, Savidge ET, Reinold MM, Zachazewski J, Gill TJ: Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy: Indications, technique, and clinical outcomes. Am J Sports Med 2009;37(7):1417-1424.

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Noble CA: Iliotibial band friction syndrome in runners. Am J Sports Med 1980;8(4):232-234.

Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg 2011;19(12):728-736

Taunton JE, Ryan MB, Clement DB, et al. A retrospective case–control analysis of 2002 running injuries. Br J Sports Med 2002;36:95 – 101.

West R, Irrgang J: Overuse injuries of the lower extremity, in Kibler W, ed: Orthopaedic Knowledge Update: Sports Medicine 4, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009, pp 181-183.

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