Etiology — what causes it
Once thought to be 'friction' over the lateral femoral epicondyle, current evidence reframes ITBS as compression and irritation of the highly innervated fat pad and connective tissue deep to the IT band (Fairclough et al., J Anat). Contributors include training error, hip abductor weakness, increased running cadence variability, and downhill running.
Epidemiology — who gets it
Second most common overuse injury in runners (after PFPS), accounting for 5–14% of running-related injuries. Also common in cyclists. Peak in recreational and distance runners.
Clinical signs
Tenderness 2–3 cm proximal to the lateral femoral epicondyle, positive Noble compression test, positive Ober test (modest sensitivity), and often hip abductor strength deficits.
Symptoms
Sharp or burning pain on the lateral aspect of the knee, often appearing predictably at a certain mileage during running. Worse on downhill running, descending stairs, and after running. Often progressive if loading continues.
Best evidence for chiropractic treatment
Conservative care is highly effective. Load reduction (temporary running volume drop), hip and glute strengthening (Fredericson et al., Clin J Sport Med), gait retraining (increasing cadence by 5–10%), and graded return are the cornerstone. Manual therapy, soft tissue work, and stretching are adjuncts. Surgery is rarely needed.
When to seek emergency care
Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.
Bottom line
ITBS responds well to load management plus hip and glute strengthening. Foam rolling alone won't fix it — capacity will.