Clinical practice in sports medicine is often guided by axioms or paradigms of practice, some of which have persisted over time despite a lack of objective evidence to support their validity. Evidence-based practice compels practicing clinicians to not only seek out and produce evidence that informs their decision-making, but also to challenge existing paradigms of thought and practice, especially when favorable treatment outcomes remain elusive. Insidious, load induced lateral knee pain around the iliotibial band in runners, cyclists, military personnel, rowers, and other athletes has for decades now been conceptualized as iliotibial band friction syndrome, a biomechanically based and unsubstantiated paradigm based on Renne’s 1975 theory that the iliotibial band slips back and forth over the lateral femoral epicondyle during flexion and extension movements of the knee, primarily irritating the underlying bursa and even the iliotibial band itself. Newer evidence about the anatomy and biomechanics of the iliotibial band, the physiology of the condition, and interventional outcomes is now available to challenge that long-held paradigm of thought for iliotibial band related pathology. Given this plethora of new information available for clinical scientists, iliotibial band impingement syndrome is proposed here as a new, evidence-informed paradigm for evaluating and treating this problematic overuse syndrome.