Up to one-in-five adults experience knee pain each year, and many seek chiropractic care to find relief from both pain and disability. While knee pain can have many causes, when discomfort is concentrated on the outside of the knee in active adults, iliotibial band syndrome (ITBS) is an important condition to consider.

The iliotibial band is a tough, fibrous band of fascia that runs from the iliac crest at the top of the pelvis down to the outer surface of the tibia just below the knee. It serves as a dynamic stabilizer of both the knee and the hip during walking and running, and research has shown that it also stores and releases elastic energy during these activities, much like a spring.

Pain from ITBS rarely begins with a single traumatic event. Instead, it typically develops after a gradual increase in running loads, such as taking on longer distances or increasing speed. The condition is estimated to account for up to 14% of all running-related injuries, but there is still debate about the exact mechanism of injury. The traditional explanation is that the band becomes irritated as it rubs back and forth over the bony prominence of the lateral femoral epicondyle as the knee bends and straightens. More recent studies, however, suggest that the band is firmly anchored to the femur and that repetitive knee motion instead compresses the soft tissues beneath it, leading to pain. A third view emphasizes the role of weak hip muscles, which reduce pelvic control and place greater strain on the ITB, creating a sprain-like overload.

Because there is no blood test or imaging procedure that can definitively diagnose iliotibial band syndrome, clinicians rely on a combination of history and physical examination while ruling out other potential causes of lateral knee pain such as meniscus injury, synovial plica syndrome, or bone stress fracture. Iliotibial band syndrome is most strongly suggested when tenderness is present directly over the lateral femoral epicondyle, when pain worsens with prolonged running, downhill activity, or stair descent, and when there is no evidence of catching, locking, or clear trauma that would indicate another problem. Findings on clinical tests such as Noble’s compression test, Ober’s test, or Renne’s test can further support the diagnosis.

Treatment of ITBS usually requires a multimodal approach. Patients often need to modify their activity levels to reduce strain on the ITB, while also addressing underlying inflammation. Rehabilitation exercises to strengthen the hip and core muscles and improve posture can restore balance, while manual therapies may be used to improve the movement of joints and soft tissues. In some cases, orthotics or footwear changes are recommended to correct ankle or foot mechanics that place additional stress on the knee. As with most musculoskeletal conditions, the earlier care is initiated, the better the outcomes. With prompt attention, patients can usually expect a satisfactory recovery that allows them to return to their usual recreational and occupational activities without lingering limitations.