Iliotibial Band Syndrome (ITBS) and the Role of Frequency Specific Microcurrent (FSM) in Pain Management

At True Vitality, we take a multi-layered approach to lifestyle and health promotion teaching people to ask new questions about their health and to consider possible solutions from interwoven perspectives.  Pain that develops in the Iliotibial Band (ITB) involves several networked, interconnecting layers of adjacent anatomical structures and tissues, reflecting a person’s lifetime of leg activity and physical forces.  

What is the ITB and what does it do? 

The ITB is a thick band of connective tissue that extends from hip to tibia and evolved along with upright human posture.  It is composed of fibrous fascia tissue, crosses both hip and knee joints and connects to two major muscles.  The ITB has important properties of physics, such as storing elastic energy and distributing force and pressure.  When in motion it transmits force from the hip down through the leg.   ITB functions include:

•       adapting during development to meet movement demands,
•       stabilizing hips and knees,
•       storing elastic energy during walking and running,  
•       behaving like a tendon for the gluteus maximus muscle,
•       transmitting more force than ordinary tendons,
•       distributing muscle force down the leg and across the knee and hip,
•       adjusting to different postures,
•       backing up the anterior cruciate ligament (ACL) to stabilize the knee and
•       attaching bones and muscles into one complex adaptive system.  

 The 2022 narrative literature review by Hutchinson et al. titled "The Iliotibial Band: A Complex Structure with Versatile Functions" explores the anatomical, biomechanical, and clinical factors influencing the iliotibial band (ITB) and iliotibial band syndrome (ITBS). The review highlights that the mechanical behavior of the ITB remains widely debated and that robust evidence for specific treatment strategies is still lacking.  

Key Findings on Anatomy and Function

•      In-Series Musculature: The complexity of the ITB stems from its two attached in-series muscles: the tensor fascia latae (TFL) and the gluteus maximus (GMAX).
•      Force Transmission: How the TFL and GMAX transmit force through the ITB during movements like walking and running is still not fully understood.
•      Evolutionary Context: The ITB is an anatomically distinct human feature tied to bipedalism, yet fundamental knowledge of its healthy mechanical behavior remains limited.  

How does the ITB develop?

From a developmental perspective, consider how the ITB changes and adapts over a lifetime.  Hutchinson et al. (2022) note that the ITB is not present at birth and develops as children walk independently. The ITB is constructed of both tendon and fascia fiber bundles, responding to the types of force distributed down through the leg.    Some features of the ITB appear to adapt to changes in leg use and locomotion.  The scientific review identifies significant ITB variations within the population regarding: 

•       ITB size in width and thickness,
•       alterations for posture and muscle activation,
•       percentage of the GMAX muscle inserted into the ITB and
•       up to five possible muscle insertion points into the ITB (Reuell; Hutchinson et al).   

A reasonable explanation for this wide variety of differences is that as the ITB evolves, it adapts precisely to how much force the leg has to accommodate over a wide range of physical labor, sports participation, sedentary work and force distribution, all reflected in current ITB composition and mechanics.   ITB functions also depend on location of muscle attachments, weight loading, mechanical behavior, proportion of running vs walking and posture. 

According to Carolyn Eng, a major function of the ITB is to "store energy during running, and we found its energy-storage capacity is substantially greater during running than walking, and that’s partly because running is a much springier gait. We don’t know whether the ITB evolved for running or walking; it could have evolved for walking and later evolved to play a larger role in running.” (Reuell).  The ITB acts as a spring-like tendon that allows efficient energy release when walking or running (Hutchinson et al).  It might absorb, store and distribute energy like the Achilles tendon, which Eng’s research predicted to correlate with how many GMAX fibers are inserted into the ITB.  Current science does not allow accurate measurement of how soft tissues contribute energy during different levels of force or strain or to explain how the ITB contributes to power in the legs.  

What causes ITBS pain?

The ITB is injured so frequently that ITB pain constitutes between 5-14% of all running-related injuries.  At a lifestyle level, research shows the ITBS becomes painful from overuse, increased workload or poor biomechanics.  At an anatomical and tissue level, there are hypotheses regarding what irritates and inflames the ITB.  At a cellular level, immune system's release of cytokines contributes to pain and signals repair.   

Hutchinson et al.’s (2022) literature review and current biomechanical research consensus indicates the following mechanisms and gait phases driving iliotibial band syndrome:   

Overuse or Insufficient Recovery ITBS lateral knee pain starts gradually and may increase noticeably following a higher running load, speed, distance or more downhill running.  Once inflamed, walking down stairs can irritate the ITB further.  ITBS also contributes significantly to cycling and military-related injuries. 

Friction Injury Traditionally ITBS was conceptualized as a friction injury in which the ITB repeatedly rubbed against the knee, irritating the innervated fat tissue underneath it.  More recent MRI data indicate that when the knee is flexed past 30° the ITB presses against the knee’s fat pad and irritates the nerves.   Repetitive motion can cause the ITB to become tight, leading to friction as it rubs against the lateral femoral epicondyle (the outer part of the knee).  This friction can result in inflammation, leading to pain and discomfort that can sideline athletes for weeks or even months.   

Biomechanical Mechanisms Peak Gait Phases for ITB Strain

•      Early Stance Phase: ITB strain and compression peak during the loading response of running or walking.
•      Foot Strike Transition: The highest risk occurs just after initial foot strike as the knee flexes into the 20°–30° impingement zone.
•      Deceleration Stress: During this phase, the ITB acts to decelerate internal tibial rotation and knee flexion, maximizing structural strain.
•      Single leg stance: worsens tension on the band and lateral knee pain.  

Fat Pad Compression MRI data shows that the ITB does not actually "friction rub" or snap back and forth over the bone.  Instead, pressing the fat pad against the bone irritates nerves embedded in the fat.  This compression is highly sensitive to the knee flexion angle, peaking at approximately 20° to 30° of flexion.  Altered force transmission from the attached TFL and GMAX increases this compressive force.   It is also possible, based on anatomical findings, that ITBS overuse injuries are associated with fat compression beneath the iliotibial band, rather than with repetitive friction (Hutchinson et al. 2022).  Fat is present at many places where tendons and ligaments attach to bone; in these locations the fat is rich with sensory nerve endings and blood flow, causing pain under pressure and sending proprioceptive signals to the brain.  It is hypothesized that fat between the ITB and the bone gets compressed, creating pressure on the many nerves contained in this fat pad.  

Hip muscle weakness Hip abductor (turning the leg outward) weakness often accompanies ITBS, but is not considered a cause of it.  Because hip abduction weakness usually occurs after the ITB becomes inflamed and painful, this weakness probably does not cause the syndrome.  Once pain symptoms begin, Hutchinson et al report a correlational relationship between hip adduction and knee rotation (turning inward toward center of the body, p. 1003) and development of ITBS.  They suggest “that runners may adopt a pattern that places less strain on the ITB once pain is present."   There is no clear research support for this hypothesis and muscle weakness is not considered a risk factor for ITBS.  Researchers do find strength deficits in runners with ITBS, but causation has not been demonstrated.  Hutchinson et al believe that hip muscles (especially the TFL and GMAX) might become inhibited by ITBS pain as the body tries to reduce tension in the ITB, sacrificing free movement for protection of tissue.  

ITB Stiffness or Tightness Repetitive motion can cause the ITB to become tight, leading to friction as it rubs against the lateral femoral epicondyle (the outer part of the knee).  This friction can result in inflammation, leading to pain and discomfort.    Hutchinson et al note that in treatment studies of IBS, it is hard to interpret and reliably measure the "stiffness" or "tightness" of the ITB, which is assumed to be a sign of poor ITB health.  The authors suggest an alternative hypothesis: increased ITB stiffness might be a sign the ITB is healing because stiffness tends to occur as pain and other symptoms decrease.  Healing scar tissues help stabilize broken tissue and are a necessary step in the recovery process for any physical injury.    

Do I have to wait until it hurts to do something about it?

Even with treatment, ITBS pain and discomfort can sideline workers and athletes for weeks or months.  The immune system dominates when it comes to healing acute injuries to prevent downstream problems.  Trust it.  Inflammation and the released cytokines are part of immune repair work, mobilizing body resources to rebuild damaged tissue and regain function.  Pay attention to pain signals that discourage further tissue injury and encourage reflection and new behaviors.   Listen to your body.  When the ITB gets irritated or inflamed, it broadcasts sharp and burning pain signals from the outer side of the knee (lateral knee pain).  During running, you might notice changes in your posture due to ITBS knee pain.  ITBS pain is noticeably different from Delayed Onset Muscle Soreness (DOMS) that typically resolves within 3 days after a workout.   

Put together a recovery plan that includes professional consultations.  

•      Get a proper diagnosis:  Consult your doctor or physical therapist to rule out other sources of knee pain such as meniscal tears, femoral bone stress injury, gluteal tendinopathy or a pinched nerve in the lower back.  Multiple causes can create similar pain patterns, so medical diagnosis is critical (Hutchinson 2022). 
•      Professional Consultation:  Consult with a medical professional about your patterns of repetitive movement (gait, posture, side dominance) if you have known risk factors for ITBS (previous knee injuries, surgeries, ITBS episodes, extensive time cycling, training or running).  Learn how to alter your movement patterns to protect the ITB.
•      Self-awareness:   Know your personal patterns for regulating emotions around pain, preventing fear-avoidance and pain catastrophizing, so you can make logical, effective decisions about pain reduction strategies.
•     Learn to manage pain:  Understand your personal pain signals and build routines that incorporate pain management strategies.  Proper pain management includes prevention of tissue injury, monitoring of pain, activity pacing and learning from your doctor what aspects of the pain you can or cannot control.
•      Posture & biomechanics:  Notice repetitive movements at work or in athletics and try to be aware of the smallest possible pain signals so you can make changes before pain or inflammation increases.  Pay attention to any changes in posture that you make to compensate for pain during repetitive movement.  Notice which alterations make you more comfortable and ask your physical therapist what it might mean. 
•      Cellular Level Intervention:  Consider exploring bio frequency technologies like FSM.  FSM often provides drug-free pain relief and has been shown in research to reduce inflammation and cytokine pain as well as increase mitochondrial ATP energy needed to repair cells (McMakin 2010).  

What is Frequency Specific Microcurrent?

According to the Cleveland Clinic’s website (July 2026):

• Frequency-specific microcurrent (FSM) is a technique for treating musculoskeletal pain with a low-level electrical current. A healthcare provider uses an electrical device to deliver this microcurrent to your tissues. The frequency of the current is the rate at which electrical waves come through the device (measured in hertz). Healthcare providers use specific frequencies to stimulate different body tissues.
• Frequency-specific microcurrent therapy is a type of complementary medicine. It’s not a primary treatment for any condition. But it may offer additional relief after primary treatment, especially for conditions that are difficult to treat or resist healing. Research into the benefits of FSM is still in progress. But the FDA has approved it as safe to use. It’s noninvasive, painless and it might just help.  

What can FSM add to traditional ITBS medical treatments?

It can take weeks or months for people to recover former mobility levels once the ITB gets inflamed.  FSM reduces pain at mid-level time scales at the cellular level while you heal and learn to adjust movement patterns.  Physical therapy treats ITBS at the anatomical and biomechanical levels over longer time scales while the body learns new movement patterns.  NSAIDS (e.g. Ibuprofen) and ice manage pain at the inflammation level on hourly time scales.   

Hutchinson et al (2022) note that the ITB is complicated to understand, partly due to its integration with so many different tissues.   FSM has been used successfully to reduce inflammation and pain in all of the tissues associated with ITBS: tendons, fascia, muscle, fat pads, nerves, blood vessels, periosteum and bone.  FSM application can be customized to each person's ITBS pain history, because frequencies are precise and can be administered locally to the affected leg.    

Do professional athletes trust FSM?

Yes.  Athletes who have used FSM report quicker recovery time and significant reduction in pain levels after injury or surgery, compared to traditional treatment methods alone.  Professional athletes are routinely treated with FSM for orthopedic issues at Cleveland Clinic and private clinics like FSM Sports in California; both clinics routinely incorporate the use of FSM for sport/work performance and injury recovery.  Dr. Carol McMakin treated NFL wide receiver Terrell Owens with FSM immediately after surgery, helping him recover from a career-ending injury to play 6 weeks later in the 2004 Superbowl (Montana, 2020).     

Can FSM cure ITBS?

No.  FSM does not treat the source of ITBS symptoms; it can't fix biomechanics, overuse or fat compression. 

• FSM has been shown to reduce pain in healing tissue.  Effectiveness is limited if the knee keeps getting overused or re-injured.
• FSM communicates non-invasively with the body at a cellular level, complementing traditional medicine and physical therapy.
• Research indicates that FSM reduces cytokines and peptides associated with inflammation and pain and increases endorphins (McMakin, 2017, p. 58). 
• Managing acute inflammation is important, because chronic inflammation can lead to stiffening of tissues like fascia, tendons and fat pads.  In case studies, FSM has consistently been shown to reduces the pain from inflammation.
• Research shows that FSM stimulates ATP production up to 500% in targeted tissues, giving the immune system more resources for repair.    

What is conventional treatment for ITBS?

Hutchinson et al’s review emphasizes that research lacks agreement about healthy ITB function and why ITBS develops.  Despite many proposed treatments for lateral knee pain in runners, high-level clinical evidence confirming the most effective interventions for ITBS continues to be scarce.  Conventional treatment for ITBS typically focuses on reducing inflammation and addressing the underlying causes of the syndrome, such as muscle imbalance or improper training techniques.

Standard approaches include:  

Rest: Temporarily stopping the activity that caused the injury to allow the inflammation to subside.  

Ice: Applying ice to the affected area to reduce swelling and numb the pain.  

Stretching and Strengthening: Engaging in exercises that stretch the ITB and strengthen surrounding muscles, particularly the glutes and hips.  Although hip weakness probably does not cause the syndrome, Hutchinson et al note that hip strengthening might build up ITB and associated tissues and alter local and central pain processing.   

Physical Therapy: Working with a physical therapist to correct biomechanical issues and improve flexibility.  

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Using medications like ibuprofen to manage pain and inflammation.  

Rebuild gradually:   Retraining should use gradual exposure to increasingly difficult activities.  Activity pacing allows the ITB and associated muscles to rebuild and adapt between workouts to increasing demands.  Re-injury can be avoided by not increasing training speed or intensity too drastically.

What if we add physics into the equation?

Hutchinson et al note that the largest research gap regarding ITBS is limited knowledge about healthy ITB mechanical function and how the GMAX contributes to long term ITB strain.  True Vitality looks at these issues from a new angle, considering the bioenergetic system underlying human locomotion and tissue regeneration.  For example, piezoelectric effects can explain one way stretching and strengthening workouts help heal the ITB.

The ITB’s physical properties appear to be two major functions of a healthy ITB: transmitting physical force and storing and releasing energy through leg anatomy.  Many body tissues, including bone, blood vessels and connective tissue, create their own electricity for daily function.  This piezoelectric effect is the process where physical movement, compression or stretching of biological tissues creates tiny electrical charges through structural components in skin, collagen, bone and connective tissue that have ordered molecular arrangements that convert mechanical stress into bioelectric signals and energy packets (Hammer; Wu et al). 

• Bone: The organic and crystalline matrix of bone generates electrical potentials when loaded with physical weight or impact.  The tiny electrical currents produced by physical stress signal bone-building cells (osteoblasts and osteoclasts) to strengthen areas experiencing the load (Wu et al). Electrical current has been used medically to stimulate healing in resistant bone fractures for decades, capitalizing on bone’s electrical properties. Weight bearing exercise is often prescribed to counter osteoporosis, also building on this piezoelectric effect.

• Collagen and Fascia: The fibrous network wrapping muscles and organs contains collagen, which acts as a natural piezoelectric material responding to stretch and pressure.  Mechanical loading and movement generate electrical microenvironments that guide stem cell migration and maintain the matrix between cells during tissue repair.  Local electrical shifts help coordinate interstitial fluid flow and hydration in connective tissue matrices (Wu et al).

• Neurons:  Nerve cells rely on electrical conduction to communicate with other cells, particularly other nerve cells.  Electrical signals travel down nerve axons, where the message is converted to release a chemical neurotransmitter when communicating with another nerve cell.  After injury, neural networks can reconstruct if electrical signals are synchronized with nerve activity; this is known as neuroplasticity.  

• Other Proteins: Tendons, cartilage, keratin, and muscle proteins like actin and myosin also exhibit these electromechanical properties (Hammer).  For example, the spinal ligaments allow electrical currents to pass through their water and ion content.  Ligaments consist of soft tissue containing significant amounts of water with dissolved minerals and electrolytes that carry electrical charges. Cerebrospinal fluid carries charge in a similar manner to and from the brain on a daily circadian cycle.

The growing field of Electroceuticals is summarized by Wu et al (2024).  The authors review current research in using organic and inorganic piezoelectric materials for medical treatments.  Organic piezoelectric materials include cellulose and collagen that have good biocompatibility.  Inorganic or combination piezoelectric materials include zinc oxide, barium titanate and quartz.  Some synthetic piezoelectric materials generate electricity and others conduct electricity.  Current research focuses on making these new medical materials safe and biodegradable.

Research shows that application of FDA-approved biomedical piezoelectric materials leads to cell growth, cell differentiation, cell communication and stem cell migration.  These materials have been studied with bone, skin (wounds) and nerve regeneration.  Some new materials demonstrate additional anti-inflammatory and anti-bacterial effects.

The physics of bioenergy is an innovative layer in scientific exploration about body repair.  Humans evolved inside the context of a unique biosphere.  We understand how the biosphere protects us from solar radiation and provides water and oxygen-rich air.  But we tend to overlook the possibility that our bodies are a microcosm that contains and reflects the same physical forces and properties that make the planet’s biosphere unique.   

References

Cleveland Clinic.  2026.  https://my.clevelandclinic.org/health/treatments/15935-frequency-specific-microcurrent  

Hammer, Warren DC, MS, DABCO.  2002. https://dynamicchiropractic.com/article/15481-piezoelectricity-a-healing-property-of-soft-tissue  

Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. 2022.  The Iliotibial Band: A Complex Structure with Versatile Functions. Sports Med. 2022 May;52(5):995-1008. doi: 10.1007/s40279-021-01634-3. Epub 2022 Jan 24. PMID: 35072941; PMCID: PMC9023415. 

McMakin, C.  2010.  Frequency Specific Microcurrent in Pain Management, Textbook for practitioners.  Elsevier Science Press, Edinburgh.

McMakin, C. 2017.  The Resonance Effect; How frequency specific microcurrent is changing medicine.  North Atlantic Books, Penguin Random House, Berkeley.  

Montana, K. 2020.  You can find a copy of the article at https://frequencyspecific.com/wp-content/uploads/2020/06/WDDTY-Kate-Montana-March-2020-FSM-article.pdf).   

Reuell, Peter. 2015.  https://news.harvard.edu/gazette/story/2015/08/understanding-the-it-band/  

Wu Y, Zou J, Tang K, Xia Y, Wang X, Song L, Wang J, Wang K, Wang Z. 2024.  From electricity to vitality: the emerging use of piezoelectric materials in tissue regeneration. Burns Trauma. 2024 Jul 2;12:tkae013. doi: 10.1093/burnst/tkae013. PMID: 38957661; PMCID: PMC11218788.