Exercise Program for Iliotibial Band Friction Syndrome

If you have iliotibial band friction syndrome (ITBS), what should you expect from a physical therapy exercise program?

Iliotibial band friction syndrome is a painful condition that typically affects runners and athletes, although anyone can experience it at one time or another. The symptoms include sharp or burning pain on the lateral, or outside, aspect of your knee. Pain is usually worse with running and better with rest, although people with severe cases of ITBS may experience pain while resting.

If you have ITBS, you may benefit from physical therapy to help control your symptoms and to help restore your normal activity level. The goals of physical therapy are:

Decrease pain and inflammation
Improve flexibility
Improve strength
Regain normal functional mobility.

One of the most important components of your ITBS rehab is exercise. Your physical therapist should prescribe exercises that you can do in the PT clinic and as part of a home exercise program. Exercises should focus on specific impairments that you have that may be causing your Iliotibial band pain.

Here is a sample exercise program for ITBS that your PT may prescribe for you. It starts with gentle stretches for your IT band and progresses to strengthening, balance, and plyometric exercises. Remember, each person's injury is unique, and your specific exercise program for ITBS may be different. You must check in with your healthcare provider before starting this, or any other, exercise program for Iliotibial band friction syndrome.

Iliotibial Band Stretches

Woman practicing pigeon pose — Hero Images / Getty Images

Your physical therapist may prescribe iliotibial band stretches as part of your rehab program for ITBS. These exercises help to gently elongate your iliotibial band, improving the tissue's ability to withstand stretching forces to it.

Iliotibial band stretches may include:

The standing iliotibial band stretch
The side-lying iliotibial band stretch
The pigeon stretch

Perform each stretch three to five times, holding the stretch for thirty seconds. Be sure to relax fully while stretching.

If you feel any pain while stretching your iliotibial band, stop and check in with your physical therapist.

Hamstring and Quadriceps Stretches

Photo of a woman stretching her hamstrings. — Thinkstock / Getty Images

Sometimes, other muscles of your thighs and legs may be implicated as a culprit in your ITBS pain. Your physical therapist may prescribe stretches for your quadriceps or hamstrings to help improve the overall flexibility around your thigh and knee joint.

Stretches may include:

The towel quad stretch
The towel hamstring stretch
The standing hamstring stretch
The side-lying quad stretch

Hold each stretch for thirty seconds and perform each stretch three to five times. If you feel any pain while stretching, stop and check in with your physical therapist.

Hip Strengthening Exercises

Ben Goldstein

The gluteus medius muscle is responsible for keeping your knees In the correct alignment while you are walking, running, or jumping. If they are weak, you may suffer from a "collapsing kinetic chain;" your knee may turn inwards as you are running. This can place incredible stress and strain on your knee and iliotibial band.

If you have ITBS, you may benefit from hip strengthening exercises. These may include:

Perform 10 to 15 repetitions of each exercise, three to four times per week. You should stop the exercises and see your physical therapist if you feel any pain in your knee.

Quadriceps Strengthening Exercises

Woman doing leg extensions — Bill Oxford / E+ / Getty Images

Your physical therapist may prescribe exercises to help strengthen your quadriceps muscles if you have ITBS. Quad exercises may be done to help improve the neuromuscular control of your VMO, a specific part of your quad that can help control the position of your kneecap and knee.

Quad exercise may include:

Quad sets
The short arc quad (SAQ) exercise
Straight leg raises
Mini squats
Leg extension exercises

Perform 10 to 15 repetitions of each exercise, three to four times per week. Be sure to stop if you feel pain in your knee or leg as you work on strengthening your quads.

Balance and Proprioception Exercises

Photo of a wobble board. — Rollover / Getty Images

Many patients with ITBS have impaired balance and proprioception and benefit from performing specific balance exercises. Proprioception is your body's sense of where it is in its environment. Specific nerve endings and report to your brain about the position of your joints and muscles and the amount of strain on your muscles. Impaired proprioception may cause your knee to be in the wrong position while running, leading to excessive stress on your iliotibial band.

Balance exercises that your physical therapist may prescribe may include:

Single leg stance
The T-stance
BOSU or wobble board standing
The BAPS board

Your PT can instruct you on how to make the most of your balance program and how to perform the exercises as part of your home program.

Plyometrics

Photo of an athlete doing a box jump. — John Fredele / Getty Images

Running requires that you go through a flight phase—no part of your body is in contact with the ground. This means that you will have to land on one foot and then push off again when you run.

Your physical therapist may have you work on your ability to accept weight through your leg and push off again with plyometric exercises. Learning to jump and land with your knee in the correct position may be necessary to keep strain off your IT band while running. The drop-jump test may also be used as an exercise for you to practice keeping your knees in the optimal position while you run and jump.

Putting It All Together

Man running through park — Westend61 / Getty Images

If your iliotibial band friction syndrome is keeping you from running, your ultimate goal of rehab is to get back on the road. This means that after a few weeks of working on flexibility, balance, strength, and leaping it may be time to test out your running tolerance. Your physical therapist may offer you specific strategies to get you back to running form again. These may include:

Video running analysis
Changing your running form
Putting together a return to running plan with a gradual increase in mileage and running pace

Iliotibial band friction syndrome can be a difficult condition to treat. It may require that you take a break from running for a few weeks. Working on specific impairments with exercises that your physical therapist prescribes may be necessary to improve your body's ability to manage the forces that are placed upon it while running. Exercises, like the ones in this program, should be the foundation of your rehab program.

By working closely with your PT and by working to improve your strength, mobility, and balance you can improve your chances of returning to pain-free running and activity quickly and safely.

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