Physio Network [Golden Oldie] Assessing and treating ITB pain with Dr Rich Willy
Feb 11, 2026
Dr Richard Willy, PT researcher and clinician focused on injured runners, discusses iliotibial band pain and rehab. He explains why compression under the ITB matters, how downhill and overstride raise risk, and why some treatments only give short relief. Practical strategies include staged loading, uphill walking, strength work resembling tendinopathy rehab, and using gait tweaks as temporary aids.
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ITB Is A Human Energy Storage Structure
- The iliotibial band is uniquely human and develops with upright walking and running.
- It functions as a large energy-storage/release structure and stabiliser, especially during downhill and sprinting.
Training Load Over Structural Blame
- Rapid increases in training load, not foot overpronation or 'tight' ITB, are the primary drivers of ITB pain.
- Overstriding (long steps) increases strain on the ITB and is a key running biomechanical factor to check.
Compression Replaces Friction Model
- The friction model has largely been replaced by a compression model of ITB pain.
- Compression irritates highly innervated tissues under the ITB when load increases too quickly.
