Proximal Iliotibial Band Syndrome: How It Affects Runners

Head 2 Toe Osteopathy
53 minutes ago
3 min read

Proximal iliotibial band syndrome (proximal ITBS) occurs when irritation, compression, or overload develops at the upper portion of the iliotibial band near the hip, rather than at the more commonly known friction point at the knee. For runners, the consequences can be significant because the proximal ITB plays a major role in pelvic stability, hip control, and load transfer during every stance phase of gait.

Why Proximal ITBS Develops in Runners

Running places high repetitive forces on the hip complex, and the ITB serves as a tensioning structure that stabilises the lateral hip and knee. Proximal irritation is usually driven by a combination of:

Pelvic drop or hip adduction during stance: Excessive dropping of the opposite hip or inward collapse of the stance leg increases tension on the proximal ITB and amplifies compression where it attaches near the TFL and the lateral hip.

TFL dominance and glute weakness: Runners who rely heavily on the TFL for hip stabilisation (often because the glute med or glute max are underactive or fatigued) create a local overload at the proximal ITB attachment.

Stride mechanics: Overstriding, low cadence, or excessive crossover gait can increase hip adduction and internal rotation, all of which raise tension in the ITB.

Training load spikes: Rapid increases in mileage, hill work, or speed sessions amplify proximal hip loading and can irritate the structure.

How Proximal ITBS Presents in Runners

Symptoms are often different from classical ITB knee pain. Runners typically report:

Pain or deep aching on the lateral hip, often near or slightly inferior to the iliac crest.
Tenderness at the TFL/ITB origin, occasionally radiating down the lateral thigh.
Symptoms that worsen with increased running volume, downhill running, lateral movements, or prolonged single-leg stance.
Sometimes stiffness or tightness that feels like “the IT band needs to be stretched,” even though stretching the band itself is not mechanically feasible.

Many runners initially mistake proximal ITBS for trochanteric bursitis, gluteal tendinopathy, or hip flexor issues, which can delay correct management.

Proximal Iliotibial Band Syndrome: How It Affects Runners

Functional Impact on Running Gait

Proximal ITBS disrupts several elements of running mechanics:

Reduced hip stability: Pain at the lateral hip often causes subconscious protective patterns—shorter stride, reduced hip extension, or increased trunk lean—which further destabilise the pelvis.

Increased reliance on the TFL: Because the TFL is painful yet overworking, the runner may compensate by recruiting it even more, perpetuating the cycle.

Altered loading through the kinetic chain: Compensations at the hip can increase stress at the knee and lower leg, predisposing runners to secondary issues such as patellofemoral pain or medial tibial stress.

Implications for Rehabilitation

Effective rehab requires addressing the root drivers of proximal ITB load, not just local pain.

Key interventions include:

Targeted strengthening

Glute med and glute max progression: isometrics → controlled single-leg → power.
Hip extension and abduction strength to reduce TFL dominance.

Motor control and gait retraining

Reducing pelvic drop and crossover gait.
Adjusting cadence (often increasing by 5–10 percent) to decrease hip adduction moments.

Load management

Modifying intensity and terrain to maintain tissue tolerance while symptoms calm.
Cross-training strategies that keep fitness high without worsening irritation.

Soft tissue treatment