21/01/2026
Proximal iliotibial band syndrome (proximal ITBS) occurs when irritation, compression, or overload develops at the upper portion of the iliotibial band near the hip, rather than at the more commonly known friction point at the knee. For runners, the consequences can be significant because the proximal ITB plays a major role in pelvic stability, hip control, and load transfer during every stance phase of gait.
Why Proximal ITBS Develops in Runners
Running places high repetitive forces on the hip complex, and the ITB serves as a tensioning structure that stabilises the lateral hip and knee. Proximal irritation is usually driven by a combination of:
- Pelvic drop or hip adduction during stance:
Excessive dropping of the opposite hip or inward collapse of the stance leg increases tension on the proximal ITB and amplifies compression where it attaches near the TFL and the lateral hip.
- TFL dominance and glute weakness: Runners who rely heavily on the TFL for hip stabilisation (often because the glute med or glute max are underactive or fatigued) create a local overload at the proximal ITB attachment.
- Stride mechanics: Overstriding, low cadence, or excessive crossover gait can increase hip adduction and internal rotation, all of which raise tension in the ITB.
- Training load spikes: Rapid increases in mileage, hill work, or speed sessions amplify proximal hip loading and can irritate the structure.
How Proximal ITBS Presents in Runners
Symptoms are often different from classical ITB knee pain. Runners typically report:
- Pain or deep aching on the lateral hip, often near or slightly inferior to the iliac crest.
- Tenderness at the TFL/ITB origin, occasionally radiating down the lateral thigh.
- Symptoms that worsen with increased running volume, downhill running, lateral movements, or prolonged single-leg stance.
Sometimes stiffness or tightness that feels like “the IT band needs to be stretched,” even though stretching the band itself is not mechanically feasible.
Many runners initially mistake proximal ITBS for trochanteric bursitis, gluteal tendinopathy, or hip flexor issues, which can delay correct management