Marathon training ITB friction syndrome

Diana’s Marathon Preparations

With approximately 15 weeks until the 2024 Nike Melbourne Marathon Festival, there are a lot of runners pounding the pavement in preparation for the Festival’s various events, myself included. This year I will be running my first half marathon! I was largely inspired by my husband, who completed his fourth marathon at this event last year with a blistering PB. At the time I was 11 months postpartum after the birth of my second son, and felt somewhat fit enough to set myself the challenge. A bonus was that I was able to convince the PMPP team to come along for the ride with me!

Even as a Sports Physiotherapist, I am not immune to niggles and injuries. On my longer training runs, I have been experiencing some left sided lateral (outer side) knee pain. A condition known as ‘Iliotibial Band Friction Syndrome (ITBFS)’ is an inflammatory condition where the ilitiobial band (ITB) rubs on a bony prominence at the lateral knee when the joint is flexed 25-30 degrees. This is approximately the angle of knee flexion when the foot strikes the ground. As a result, there is a collection of fluid near the ITB attachment at the knee joint. The pain associated with this can vary from mild to severe. Luckily, I am able to continue running and my main symptoms are that the pain often is worse up to 24-48 hours after a long run, especially going up and down the stairs repeatedly with the kids!

Marathon and other long distance runners are especially prone, however other contributing factors include:

  • Downhill running, or running on a sloped/uneven surface
  • A rapid increase in training volume
  • Excessive foot pronation
  • Pelvic muscle imbalance; often weakness of the gluteal and trunk muscles but also excessive muscle tightness of tensor fascia lata (TFL), gluteal muscles and iliotibial band
  • Inappropriate footwear (either too old, or often not cushioned enough to provide adequate shock absorption)


Treatment, and my own management, has included:

  • Relative rest, and trying to space my runs accordingly during the week. I will leave 48 hours after my long runs on a Sunday until my next run, which is often only a slow and short 5km. I am aiming to run 3 times per week, with no steep increases in volume or intensity each week. Load management is one of the most vital measures in injury prevention.
  • I have a few pairs of runners on rotation, mostly with an emphasis on cushioned shoes. If you are training for any sort of long distance event, I strongly advise to be fitted professionally for runners. The Running Company (Albert Park) and Active Feet (Sandringham, Prahran) are 2 stores I recommend to patients, and use personally.
  • Strengthening exercises. A major contributing factor for ITBFS is muscle weakness, particularly of the gluteal muscles. My left hip is, and always has been, not as strong so it is of no surprise my left knee is troubling me. I do strength training at the gym x3-4 per week, and work on various mainly lower body strengthening exercises. I also incorporate as many single leg exercises as I can to isolate my left side. Examples include: squats, deadlifts, bulgarian split squats, crab walks, hip thrusts. I cannot recommend strength training in runners enough.
  • Mobility/Stretching exercises of the ITB and surrounding muscles (gluteals/quadriceps/adductors/hip flexors). This can be done in various forms. Physiotherapy treatment, Remedial Massage, foam rolling, Theragun, Spikey ball and Dry Needling.
  • Ice and anti inflammatories can also help with pain and recovery



By Diana Emmerson (APA Sports & Exercise Physiotherapist)







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