Patient Case Study: Iliotibial band pain – but not an iliotibial band injury

Iliotibial band

A lovely 40 something gentleman came to see me last year as he had been struggling with right sided knee pain which had been ongoing for two years. He was not aware of any injury, which had brought this on and had been diagnosed with Iliotibial band pain. He had had treatment for this for nearly two years. However he found he was still not able to do his road-biking without pain. He was looking for another opinion, and somehow ended up on my door.

As physiotherapists we take a subjective examination (where we ask tons of medical questions) and he told me that his pain was aggravated by road biking; where he would be okay at the time, but then the following day he would get stabbing pains on the side of the knee over the Iliotibial band and it would take about 2 days to go.

His past medical history included two MRI scans which showed nothing abnormal. He had furthermore had 2 cortisone injections, which made little progress.

Asking further back into older injuries he mentioned that he fell off his bike 8 years ago and had hurt his left hip. There was noticeable scar tissue, numbness and a haematoma over the hip at the time. He never received physiotherapy for this, but felt that it was fine.

Research has been done into the effect injuries have on the rest of our body and it has been proven that if you hurt any part of your leg, your core stability in your hip will “stop” activating and become weak.

This will then create a weakness in your mechanical chain and other structures will have to work harder to compensate.

After an integrative/holistic physical examination, I found that the reason he was suffering from right knee pain was because the scar tissue on the left hip was adversely affecting the core stability muscles ability to activate. This in turn was affecting his spiral line fascial tension making the Iliotibial band on the right side overwork during biking. There were global as well as intrinsic biomechanical imbalances.

Spiral-line1  Spiral Line

I saw my client 4 times focusing on softening the left hip scar tissue, core stability training exercises related to biking; incorporating release of the spiral fascial line as well as rebalancing the Quad/Hamstring strength ratio and after one month, he was pain-free and back to his road biking.

It was not necessary to treat his Iliotibial band because as soon as the muscle and fascial imbalances were addressed and sorted, the iliotibial band relaxed and stopped irritating the knee.


Sometimes the pain we are experiencing can be due to other factors, so if you have an injury that does not seem to improve or settle – and want a second opinion – feel free to contact me for an assessment – I’d be happy to help.


 Tina Nielsen- Talbot BSc MCSP HCPC

Integrative and Holistic Physiotherapist

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