Iliotibial Band Syndrome (ITBS)

October 7, 2025

Causes, Symptoms & Treatment | Weaver Physiotherapy Northwich

Understanding Iliotibial Band Syndrome


If you’re a runner, cyclist, or active individual experiencing pain on the outer side of your knee or thigh, you could be dealing with Iliotibial Band Syndrome (ITBS) — one of the most common causes of lateral knee pain in athletes.


At Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire, our team of Chartered Physiotherapists specialises in diagnosing and treating Iliotibial Band Syndrome, helping runners and athletes of all levels recover quickly, move freely, and prevent recurrence.


With over 70 years of combined clinical experience, our physiotherapists combine hands-on treatment, advanced rehabilitation, and movement re-education to tackle ITBS at its source.


What Is the Iliotibial Band?


The iliotibial band (ITB) is a thick band of connective tissue that runs from the hip to the outer side of the knee, connecting the tensor fasciae latae (TFL) and gluteus maximus muscles to the tibia (shin bone). Its role is to stabilise the knee and hip during movement, particularly when running, walking, or cycling.


When functioning properly, the IT band glides smoothly over the bony structures around the knee. However, if it becomes tight, inflamed, or irritated from repetitive friction, it can cause pain on the outside of the knee — the hallmark of Iliotibial Band Syndrome.


What Causes Iliotibial Band Syndrome?


ITBS is an overuse injury, meaning it develops gradually from repetitive stress rather than a single traumatic event. The condition is especially common among runners, cyclists, hikers, and gym-goers who perform frequent bending and straightening of the knee.


Common Causes Include:

    1.    Overtraining or Sudden Increase in Activity

Increasing your mileage, pace, or hill training too quickly can overload the IT band and surrounding structures.

    2.    Muscle Imbalances and Weakness

Weak gluteal or hip stabilising muscles cause the IT band to take on excessive tension, leading to irritation around the knee.

    3.    Tightness in the IT Band or Hip Muscles

Limited flexibility in the TFL, glutes, or quadriceps can increase friction along the IT band.

    4.    Poor Running Form or Biomechanics

Excessive inward knee movement (valgus), overstriding, or poor hip control can increase stress on the outer knee.

    5.    Improper Footwear or Running Surface

Worn-out shoes, excessive camber (running on sloped surfaces), or running always in one direction can contribute to ITBS.

    6.    Leg Length Discrepancy or Pelvic Alignment Issues

Subtle biomechanical differences can lead to uneven stress distribution across the knees and hips.


Who Is Most at Risk?


Iliotibial Band Syndrome can affect anyone who is active, but some groups are particularly prone to it:

    •    Distance runners, especially those training for marathons or half-marathons

    •    Cyclists with poor bike setup or excessive mileage

    •    Hikers tackling long or uneven terrain

    •    Footballers, rugby players, and gym-goers doing repetitive squatting or lunging

    •    Office workers with tight hip flexors or glutes due to prolonged sitting


If you’re training hard but developing sharp or aching pain on the outside of your knee, you may be in the early stages of ITBS.


Symptoms of Iliotibial Band Syndrome


The hallmark symptom of ITBS is pain on the outer (lateral) side of the knee, but the condition can cause a range of sensations and discomfort patterns.


Common Symptoms Include:

    •    Sharp or burning pain on the outside of the knee

    •    Pain that worsens with running, especially downhill or after several miles

    •    Discomfort when climbing stairs or getting up from a seated position

    •    Tightness or tenderness along the outer thigh

    •    Snapping or clicking sensation around the knee

    •    Pain that may radiate up towards the hip or down the leg


The pain often starts gradually and worsens with continued activity. Early intervention is crucial to prevent the condition from becoming chronic.


How Is Iliotibial Band Syndrome Diagnosed?


At Weaver Physiotherapy, our expert clinicians take a comprehensive approach to diagnosis. We don’t just treat the pain — we identify the underlying cause.


Our ITBS Assessment Includes:

    1.    Detailed Case History

Understanding your training habits, footwear, injury history, and lifestyle factors.

    2.    Physical Examination

Assessing hip, knee, and ankle alignment, as well as muscle strength and flexibility.

    3.    Movement Analysis

Evaluating running gait, walking pattern, or cycling posture to identify mechanical contributors.

    4.    Palpation & Orthopaedic Tests

Testing specific structures to rule out other causes of knee pain (e.g., meniscus injury, lateral ligament strain).

    5.    Video Gait Analysis

Using slow-motion technology to spot subtle biomechanical issues that lead to ITB irritation.


This holistic assessment ensures your treatment plan is tailored to your individual needs and the root cause of your problem.


Physiotherapy Treatment for Iliotibial Band Syndrome


1. Pain Relief and Inflammation Management


The first goal is to reduce pain and inflammation. Your physiotherapist may use:

    •    Manual therapy and soft tissue release to ease tension along the IT band and surrounding muscles.

    •    Ice therapy or ultrasound for inflammation control.

    •    Kinesiology taping to offload the IT band and support healing.


2. Deep Tissue and Sports Massage


Massage therapy is extremely effective in reducing IT band tightness. At Weaver Physio, our Sports Massage and Deep Tissue Massage treatments target the TFL, glutes, quadriceps, and lateral thigh to restore normal tissue mobility and reduce friction at the knee.


3. Shockwave Therapy


For chronic or stubborn cases, Shockwave Therapy provides a powerful, evidence-based solution. It uses acoustic waves to stimulate blood flow, break down scar tissue, and accelerate healing in the IT band and surrounding tendons. NICE (National Institute for Health and Care Excellence) recommends this treatment for persistent soft tissue conditions.


4. Strength & Conditioning Rehabilitation


Once pain is under control, strengthening exercises are essential to correct underlying imbalances. Your physiotherapist will design a tailored exercise program targeting:

    •    Gluteus medius and maximus (hip stabilisers)

    •    Core muscles (for pelvic control)

    •    Hamstrings and quadriceps (to balance knee mechanics)


5. Gait Re-Education


Poor running form often drives ITBS. Our Runner’s MOT and Video Gait Analysis sessions identify biomechanical inefficiencies, helping you adjust stride length, cadence, and posture for long-term prevention.


6. Stretching and Mobility Work


Specific stretches for the IT band, TFL, glutes, and quads help relieve tension and maintain flexibility. Foam rolling and mobility drills may also be prescribed.


7. Return to Sport Planning


We guide you safely back into training with progressive loading, ensuring your tissue capacity matches your running or cycling demands.


At Weaver Physio, your treatment plan is completely individualised — addressing pain relief, restoring function, and preventing recurrence.


Exercises for Iliotibial Band Syndrome


Here are a few examples of physiotherapy-approved exercises often included in recovery plans:

    1.    Side-Lying Leg Raises – Strengthens the gluteus medius.

    2.    Clamshells – Targets hip stabilisers and improves knee alignment.

    3.    Hip Bridges – Builds glute strength and reduces ITB tension.

    4.    Foam Rolling the IT Band – Helps release tight fascia and improve mobility.

    5.    Standing IT Band Stretch – Gently lengthens the lateral thigh structures.


(Always consult your physiotherapist before starting new exercises, as incorrect technique can worsen symptoms.)


How Long Does Recovery Take?


Recovery time depends on severity, chronicity, and training load, but most patients improve significantly within 4–8 weeks of structured physiotherapy and activity modification. Chronic or long-standing cases may take longer, especially if biomechanical retraining is needed.


Our goal at Weaver Physio is to not only get you pain-free, but also to build resilience so you can return to running, cycling, or sport with confidence — and without fear of re-injury.


Preventing Iliotibial Band Syndrome


1. Gradual Training Progression


Avoid sudden increases in distance, pace, or hill work. Follow the 10% rule – increase weekly mileage by no more than 10%.


2. Strengthen Your Glutes & Core


Regular hip and core strengthening reduces ITB strain during movement.


3. Prioritise Flexibility


Incorporate regular stretching and foam rolling of the IT band, quadriceps, hamstrings, and calves.


4. Check Your Footwear


Replace worn-out shoes and ensure your trainers match your running style. Gait analysis can identify whether you need neutral or stability shoes.


5. Cross-Train & Rest


Include low-impact activities like swimming or cycling, and schedule adequate rest days to allow tissue recovery.


6. Get a Professional Running Assessment


Our Runner’s MOT identifies inefficiencies in your stride and recommends personalised corrective exercises — ideal for injury prevention and performance enhancement.


Why Choose Weaver Physiotherapy for IT Band Syndrome Treatment?


At Weaver Physiotherapy & Sports Injury Clinic, we’re passionate about helping runners, athletes, and active individuals overcome injury and return to what they love.


What Sets Us Apart:


✅ Specialist Running Injury Clinic – Experts in ITBS, runner’s knee, Achilles pain, and shin splints

✅ 70+ Years Combined Experience – Trusted Chartered Physiotherapists in Cheshire

✅ Comprehensive Assessment – Including video gait analysis and functional testing

✅ Advanced Treatments – Shockwave therapy, acupuncture, sports massage, rehab & manual therapy

✅ Tailored Rehabilitation Plans – Designed around your sport, goals, and lifestyle

✅ Local, Trusted Experts – Serving Northwich, Knutsford, Winsford, Middlewich, Frodsham & Tarporley


Whether you’re a Parkrunner, marathoner, or simply love staying active, our mission is to help you move better, perform better, and live pain-free.


Take Control of Your Recovery Today


Don’t let IT band pain stop you from doing what you love. Early intervention is key — the sooner you seek help, the faster you’ll recover.


📞 Call Weaver Physiotherapy & Sports Injury Clinic today on 01606 227484

🌐 Book online at https://www.weaverphysio.com

📍 Weaver Physio – Your Trusted Partner in Recovery, Performance & Pain-Free Living


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Knee pain is one of the most common musculoskeletal complaints we see at Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire. From runners and athletes to office workers and retirees, knee problems can affect anyone. While many people are familiar with conditions such as arthritis, meniscus tears, or ligament injuries, one often-overlooked cause of knee swelling and discomfort is a Baker’s Cyst. Also known as a popliteal cyst, this condition can cause swelling behind the knee, stiffness, and reduced mobility – and if untreated, it may lead to ongoing pain or limit your ability to exercise, walk comfortably, or perform daily activities. In this in-depth guide, we’ll explain what a Baker’s Cyst is, the symptoms to look out for, why it develops, and most importantly – how physiotherapy can help you manage, treat, and prevent it. What is a Baker’s Cyst? A Baker’s Cyst is a fluid-filled swelling that develops behind the knee, in the popliteal space. It occurs when excess joint fluid (synovial fluid) escapes from the knee joint and collects in a small sac behind the knee. This fluid build-up is often a result of an underlying knee problem, such as: • Osteoarthritis (wear and tear of the knee joint) • Rheumatoid arthritis • Meniscus injuries (cartilage tears) • Ligament injuries • Knee joint inflammation The cyst itself is not dangerous, but it can be painful, restrict movement, and cause the back of the knee to feel tight – especially when bending or straightening the leg. Symptoms of a Baker’s Cyst Some people with a Baker’s Cyst may not experience symptoms at all, especially if the cyst is small. However, when symptoms do occur, they may include: ✔️ A noticeable lump or swelling behind the knee ✔️ Tightness or stiffness in the back of the knee ✔️ Pain or aching, particularly when straightening or bending the leg ✔️ Reduced flexibility and mobility ✔️ Swelling in the calf (if the cyst bursts and fluid leaks down the leg) In rare cases, a ruptured Baker’s Cyst can mimic the symptoms of a blood clot (deep vein thrombosis – DVT), with sudden calf swelling, pain, and redness. If you experience these symptoms, urgent medical assessment is required. Causes: Why Do Baker’s Cysts Develop? A Baker’s Cyst does not develop in isolation – it usually results from knee joint changes or injury that causes excess fluid production. Common causes include: 1. Arthritis • Osteoarthritis is a major cause. As the cartilage wears down, the joint becomes inflamed, leading to fluid build-up. • Rheumatoid arthritis, an autoimmune condition, can also trigger joint swelling and cyst formation. 2. Sports Injuries • Damage to the meniscus (cartilage) can irritate the joint and lead to cysts. • Ligament injuries (ACL, MCL) may also increase fluid build-up. 3. Overuse or Repetitive Strain • Runners, cyclists, and people who frequently squat or kneel may place repetitive stress on the knee joint, contributing to cyst formation. 4. Underlying Inflammation • Any condition that causes inflammation within the knee joint (including gout) can lead to synovial fluid leakage and cyst development. Diagnosis of a Baker’s Cyst At Weaver Physiotherapy & Sports Injury Clinic, our Chartered Physiotherapists carry out a detailed assessment to identify whether your knee pain and swelling are caused by a Baker’s Cyst, or another condition. The process may include: 🔹 Clinical assessment – checking your symptoms, medical history, and examining the back of the knee for swelling. 🔹 Ultrasound scan – often recommended to confirm the diagnosis. 🔹 MRI scan – if an underlying injury such as a cartilage tear is suspected. Early diagnosis is key. Many patients believe they just have “knee swelling” without realising it’s linked to an underlying joint issue. How Physiotherapy Helps Baker’s Cyst Physiotherapy is one of the most effective ways to manage and treat a Baker’s Cyst. While draining the cyst or surgery is sometimes required in severe cases, the majority of patients benefit from conservative treatment that targets the root cause. At Weaver Physio, our approach focuses on: 1. Pain Relief & Swelling Reduction • Manual therapy to ease stiffness • Ice, compression, and elevation strategies • Advice on activity modification to avoid aggravation 2. Improving Knee Mobility • Gentle stretching exercises to restore range of movement • Targeted flexibility work for the hamstrings and calf muscles 3. Strengthening Exercises • Quadriceps strengthening to improve joint support • Glute activation to reduce stress on the knee • Core stability to enhance overall lower-limb mechanics 4. Correcting Biomechanics • Video Gait Analysis and biomechanical assessment (part of our Runner’s MOT service) • Identifying imbalances in walking or running that may contribute to knee overload 5. Treating the Underlying Cause • If arthritis is the cause, we’ll develop a long-term joint management plan • If it’s due to a sports injury, we’ll provide a tailored rehabilitation programme Home Management Strategies Alongside professional physiotherapy, patients can often manage symptoms at home with: ✔️ Rest & Activity Modification – avoiding deep squats or repetitive knee strain ✔️ Ice Therapy – applying ice packs to reduce swelling ✔️ Compression Supports – knee braces can help control fluid build-up ✔️ Gentle Exercises – as advised by your physiotherapist When is Surgery Needed? Surgery is rarely the first option for Baker’s Cyst. It is usually only considered if: • The cyst is very large and painful • Conservative treatments have failed • The underlying cause (such as a meniscus tear) requires surgical repair In such cases, a surgeon may drain the cyst (aspiration) or repair the damaged structures inside the knee. Can a Baker’s Cyst Burst? Yes. In some cases, the cyst can rupture, releasing fluid into the calf. This can cause sudden pain, swelling, and bruising in the lower leg. It may resemble a DVT (blood clot), so it’s important to seek urgent medical advice to rule this out. Recovery Timeline Recovery depends on the underlying cause: • Minor cases: Symptoms may improve in a few weeks with rest and physiotherapy. • Arthritis-related cases: Long-term management is required, but physiotherapy helps control pain and mobility. • Sports injuries: Recovery may take 6–12 weeks, depending on the severity of the meniscus or ligament damage. At Weaver Physio, we’ll give you a personalised recovery plan so you know exactly what to expect at each stage. Preventing Baker’s Cyst While not all cases can be prevented, you can reduce your risk by: 🔹 Maintaining strong quadriceps, hamstrings, and glutes 🔹 Avoiding repetitive high-impact activities without proper recovery 🔹 Wearing appropriate footwear for your activity 🔹 Seeking physiotherapy early if you experience knee swelling or stiffness Why Choose Weaver Physio for Knee Pain? At Weaver Physiotherapy & Sports Injury Clinic in Northwich, Cheshire, we are specialists in diagnosing and treating knee injuries and conditions such as Baker’s Cyst. Here’s why patients across Cheshire – including Northwich, Knutsford, Winsford, Middlewich, Tarporley, and Frodsham – choose us: ✔️ 70+ years of combined clinical experience ✔️ Experts in sports injuries, arthritis, and musculoskeletal pain ✔️ Access to advanced services such as Shockwave Therapy, Acupuncture & Video Gait Analysis ✔️ Tailored rehabilitation plans that get to the root cause of your pain ✔️ Trusted by runners, athletes, and the local community Our goal is simple: to help you recover faster, prevent future injuries, and get back to living pain-free. Book Your Appointment If you’re struggling with knee pain or suspect you may have a Baker’s Cyst, don’t ignore the symptoms. Early treatment can make a huge difference in your recovery and long-term knee health. 📞 Call us today on 01606 227484 🌐 Visit us at http://www.weaverphysio.com Weaver Physiotherapy & Sports Injury Clinic – Your Trusted Partner in Recovery, Performance & Pain-Free Living.
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