 
Massachusetts General Brigham Sports Medicine  
 
Rehabilitation Protocol for Iliotibial Band Syndrome 
This guideline is intended to assist clinicians and patients through the non-operative course of care for Iliotibial Band 
Syndrome. This protocol is time based (dependent upon tissue healing) as well as criterion based (dependent upon 
patient tolerance). Specific intervention should be based on the needs of the individual and should consider exam 
findings and clinical decision making. If you have questions, contact the referring physician.   Also referred to as Iliotibial 
band friction syndrome, this pathology refers to lateral thigh/knee pain, typically distal, along the area where the ITB 
slides over the lateral femoral condyle at approximately 30 degrees of knee flexion.  This can be common for activities 
that require repetitive knee flexion and extension. 
 
Diagnosis 
Considerations 
• Pain: may not occur during activity, but can intensify over time  
• Common Aggravating Factors: ascending/descending stairs, downhill skiing, long distance 
running, weight training, jumping, cycling. 
• Localized tenderness over the lateral femoral condyle or Gerdy’s tubercle.  There may be 
swelling or increased density in this area.  Pain may be elicited with active flexion/extension of 
the first 30 degrees of knee motion, as the thumb compresses the ITB over the epicondyle.  Hip 
pain may also be present. 
• Patellar glides may be limited medially 
• Footwear/foot position: calcaneal varus structure, excessive internal tibial torsion.  Consider 
seat position for cyclists. 
• Common areas of weakness: hip abductors, hip adductors, knee flexion, knee extension 
• Special Tests: Muscle Length (Ober’s, Thomas), Noble compression test, creak/Renne test 
Differential 
Diagnosis 
• Lumbar Radiculopathy (or referred pain) 
• Snapping hip syndrome 
• Stress fracture 
• Sacroiliac joint dysfunction 
• TFL/Gluteus medius/gastrocnemius muscle 
strain 
• Trochanteric bursitis 
• Tendinopathy: biceps femoris, vastus 
lateralis, popliteus 
• Lateral meniscus pathology 
• Superior tibiofibular joint sprain 
• LCL sprain 
• Knee OA 
• Common peroneal nerve injury 
• Infection 
• Neoplasm 
 
PHASE I: IMMEDIATE/ACUTE INFLAMMATORY PHASE (0-2 WEEKS) 
Rehabilitation 
Goals 
• Reduce any swelling, minimize pain. 
• Restore lower extremity mobility (including hip, knee, ankle). 
• Restore tolerance to full motion. 
• Minimize arthrogenic muscle inhibition and re-establish quadriceps, hip control. 
• Patient education. 
- Minimize aggravating factors as much as possible, such as descending stairs, prolonged 
sitting, running, jumping. 
- Initial self-symptom management and joint protection. 
- Independent with initial home exercise program. 
 
 
Intervention 
During this early phase, numerous manual interventions may be utilized to reduce the patient’s pain, 
restriction to movement, and joint loading: 
• Soft Tissue Mobilization/Instrument-Assisted Soft Tissue Mobilization 
• Taping (McConnell, Kinesiotaping) 
• Ischemic compression/Bloodflow Restrictive Training 
• Dry Needling 
• Nerve mobilization 
• Joint mobilization/manipulation as indicated (lumbopelvic, coxofemoral, tibiofemoral, 
talocrural, subtalar) 
• Strengthening 
• Stretching 
 
Mobility: 
• Stationary biking for tolerable mobility (minimal resistance) 
• Walking program 
 
Strengthening: Minimal loading 
• Bridge/unilateral bridging 
• Sidelying clamshells 
• Sidelying hip abduction 
• Core/lumbopelvic stabilization (transverse abdominus, multifidus lifts, front/side planks) 
Stretching/foam rolling 
• Hip flexors (with hip adduction bias) 
• Hamstrings 
• Quadriceps 
• Iliotibial band (with care to avoid trochanteric bursa, lateral femoral condyle) 
• Adductors 
• Hip extensors/rotators 
• Gastroc-soleus complex 
Criteria to 
Progress 
• Full knee motion, compared to uninvolved side. 
• Appropriate quad contraction with superior patella glide and full active extension. 
• Full tolerance to weightbearing with relative knee extension. 
 
 
 
PHASE II: INTERMEDIATE/SUB-ACUTE REPARATIVE PHASE (2-4 WEEKS) 
Rehabilitation 
Goals 
• Progress to closed-chain/weightbearing activities without loading of knee flexion. 
• Maintain full ROM. 
• Tolerance to closed chain hip strengthening/balance without loading of knee joint in flexion. 
• Independent with progressed home exercise program, all daily activities. 
Additional 
Intervention 
*Continue with 
Phase I 
interventions as 
indicated 
Weightbearing Strengthening Progression: Extension-based Loading 
• Sumo walks 
• Monster walks 
• 4-way hip drills 
 
Balance/proprioception 
• Single-leg stance 
• Clock taps 
• Ball toss 
 
Correction of movement abnormalities with functional tasks 
Criteria to 
Progress 
• Tolerance to weightbearing activities. 
• Maintenance of full ROM. 
• Normalize muscle length or achieve muscle length goals. 
 
 
 
PHASE III: LATE/REMODELING PHASE (4-8 WEEKS) 
Rehabilitation 
Goals 
• Maintain full ROM. 
• Promote proper movement patterns. 
• Avoid post exercise pain/swelling. 
• Achieve all muscle strength goals. 
• Negotiating stairs unlimited. 
• Full tolerance to closed chain knee joint loading with flexion, with appropriate eccentric control. 
• Achieve all muscle strength goals. 
• Achieve daily/functional goals. 
Additional 
Intervention 
*Continue with 
Phase I-II 
Interventions as 
indicated 
Weightbearing Strengthening Progression: Flexion-based Loading 
• Partial squat, squat to chair, wall slide, progressing to functional squat pattern 
• Lunge/reverse lunge/slider lunge 
• Step ups 
• Step downs, eccentric loading 
• Single leg squat 
• Double leg squat jumps 
• Double leg box jumps up/down 
• Single leg hop downs 
• Single leg forward hops 
 
Correction of movement abnormalities with sport-related tasks (hip adduction, hip internal rotation, 
contralateral pelvic drop) 
 
Return to Running Program 
Criteria for 
Discharge/Return 
to Sport 
• Independent self-management of symptoms 
• Demonstrate appropriate understanding of condition and maintenance to prevent risk of 
recurrence 
Revised 11/2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
References 
1. 
McKay et al. Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study. Journal of Orthopaedic Surgery and Research 
(2020) 15:188. 
2. 
Mellinger S, Neuroh GA. Evidence based treatment options for common knee injuries in runners. Ann Transl Med 2019;7(Suppl 7):S249. 
3. 
Mucha M et al.  Hip abductor strength and lower extremity running related injury in distance runners: A systematic review.  Journal of Science and 
Medicine in Sport 20 (2017) 349–355. 
4. 
Strauss et al.  Iliotibial Band Syndrome: Evaluation and Management. J Am Acad Orthop Surg 2011;19: 728-736. 
5. 
Sueki D, Brechter J.  Orthopedic Rehabilitation Clinical Advisor.  1st ed. Maryland Heights, Missouri: Mosby; 2009.  546-7, 577-8. 
