The Evolution of Etiopathogenesis and Conservative Management of Iliotibial Band Syndrome in Long-Distance Runners: A Comprehensive Review

Iliotibial band syndrome (ITBS) is the leading cause of lateral knee pain in endurance runners, affecting up to 12% of this group (Hadeed & Tapscott, 2023). Historically, ITBS was classified as a "friction syndrome," attributed to the distal band sliding over the lateral femoral epicondyle (LFE). Recent anatomical, histological, and biomechanical studies have challenged this view, instead supporting a "compression model." This review details the shift from friction-based theories to the current understanding of impingement on innervated adipose tissue. Conservative management strategies, including traditional stretching, hip abductor strengthening (HAS), gait retraining, and adjunctive therapies such as extracorporeal shockwave therapy (ESWT) and dry needling (DN), are critically evaluated. A 2024 systematic review of 13 studies reported that multiplanar HAS and gait retraining achieved pain reduction rates ranging from 27% to 100%. Heavy Slow Resistance (HSR) training and cadence manipulation (increasing by 5–10%) are identified as key interventions for improving tissue tolerance. Effective ITBS management requires addressing both proximal hip stability and distal mechanics, while attempts to "release" the stiff, inextensible band are unlikely to provide benefit.