As a result of the frequent endurance sports that are being practiced nowadays, many techniques have been introduced to this field with favorable outcomes regarding to the management approaches of the different injuries. However, no previous investigations have adequately discussed the pathophysiology of iliotibial band friction syndrome (ITBS) based on recent evidence from the current studies in the literature. In the present investigation, we have discussed the pathophysiology and related classification of iliotibial band friction injuries based on the current studies in the literature. The current evidence about the pathophysiology of the condition is still controversial, although epidemiological investigations indicate that ITBS is becoming a more prevalent condition among runners and other endurance athletes. Furthermore, many factors can attribute to the development of the condition and have been reported to take essential roles in the pathophysiology of the disease. Some of these factors include gender, iliotibial band tightness, rearfoot eversion and weak hip abductors. Further investigations are still needed to completely understand the pathophysiology of the disease to help clinicians aim to achieve better interventions to enhance the outcome of practicing endurance and excessive exercises.