ITB Syndrome & Runner's Knee Therapy

Iliotibial band syndrome is among the most common injuries seen at this practice, and among the most frequently mismanaged in the broader physiotherapy landscape. The standard advice (rest, stretch, foam roll) addresses the symptom without touching the cause. The ITB itself is not the problem. It is a thick band of fascia that cannot be meaningfully stretched or lengthened by any amount of foam rolling. The problem is the compressive and frictional forces acting on the bursa and fat pad beneath the ITB at the lateral femoral condyle, driven by a combination of hip abductor weakness, pelvic drop during single-leg stance, and (in cyclists) saddle height and cleat position issues that alter knee tracking mechanics.

Effective management of ITB syndrome requires a gait assessment to identify the pelvic drop and hip mechanics driving the compression; a strength programme targeting the gluteus medius and hip abductors in positions that transfer to running and cycling; a progressive return-to-activity plan that manages the compressive load at the lateral knee; and, in cyclists, a review of bike position. Treatment at this practice achieves lasting resolution by addressing all of these components, not just the painful tissue.

Runner's knee (patellofemoral pain syndrome) is similarly driven by proximal weakness and altered lower limb mechanics rather than anything inherently wrong with the kneecap itself. The same comprehensive approach applies.