IT Band Pain

Cause and Treatment of Iliotibial Band Syndrome

IT Band pain in athletes
IT Band pain in athletes. Jordan Siemens/Iconica/Getty Images

The IT band is often the hidden cause of many people's outer knee or hip pain.

Iliotibial band friction syndrome can cause a nagging, dull ache, or flare into a sharp, acute pain felt at a specific spot on the outside (lateral aspect) of the knee and lower thigh. For some athletes, a tight it band may cause hip pain as well.  What's the Iliotibial Band?

The iliotibial band is a strong, thick band of fibrous tissue that runs along the outside of the leg.

The IT band starts at the hip and runs along the outer thigh and attaches on the outside edge of the shin bone (tibia) just below the knee joint. The band works with the quadriceps (thigh muscles) to provide stability to the outside of the knee joint during movement.

What Causes Iliotibial Band Pain?

Iliotibial band syndrome is typically caused by inflammation of the iliotibial band. IT band syndrome is a common injury in runners or other athletes that run for training or during their sports. The IT band acts primarily as a stabilizer during running and may become irritated from overuse. The pain is typically felt on the outside (lateral) aspect of the knee or lower thigh, but may be felt near the hip, and is often more intense when descending stairs, or getting up from a seated position.

The Most Common Causes of IT Band Syndrome

  • Faulty Biomechanics
  • Other Training Errors

IT band syndrome is common in runners who perform unbalanced, repetitive exercise such as running only on one side of a crowned road or only running one way around a track. Most roads slope off to the sides and running along the edge causes to the outside foot to be lower than the inside foot.

This, in turn, causes the pelvis to tilt to one side and stresses the IT band.

The biomechanical abnormalities that may lead to IT band problems include excessive pronation of the foot, leg length discrepancy, lateral pelvic tilt, and "bowed" legs. Muscle tightness or lack of flexibility in the gluteal (buttock) or quadriceps (thigh) muscles may increase the risk of IT band injuries. Sports physical therapists often use videotape analysis to uncover any biomechanical problems and make corrections in technique or muscle weakness or tightness.

IT Band Syndrome Treatment?

Treating IT band friction syndrome generally includes a comprehensive approach, including:

  • R.I.C.E.: Rest, ice, compression, and elevation is the best way to treat initial IT band pain.
  • Physical Therapy. A therapist may use ultrasound and other modalities to help the injured tissues heal more quickly. A skilled PT can also help you correct any biomechanical or training errors, and teach you how to perform the right flexibility exercises.
  • Reduced Activity. Runners with IT band pain should reduce running mileage and be alert for signs of overtraining syndrome.
  • Foam Roller Myofacial Release. Using a foam roller to release the tissues, may be painful, but many athletes have excellent success with this technique.

Preventing IT Band Syndrome

The following tips may help you prevent chronic IT band syndrome:

  1. If you are a runner, first review the Checklist for Running Overuse Injuries
  2. IT Band - Strengthening Exercises
    Strengthening the external hip rotators may also help reduce the risk of IT Band injuries. One simple way to do this is with the one-leg squat exercise. Perform these in front of a mirror and make sure your pelvis does not drop on one side during the reps.
    1. One-Leg Squat Exercise
  1. IT Band - Stretching Exercises
    Stretching the IT band may help prevent irritation from IT band tightness.
    1. Standing IT Band Stretch
    2. Advanced IT Band Stretch for IT Band Pain
    3. Crossover Squat Stretch
    4. Foam Roller Exercises to Stretch the IT Band
  2. Use the Right Shoes. The amount of support or cushion in your shoes can either aggravate or alleviate IT band issues, so be sure to choose the right shoes for your sport.  
  3. Consider Using Orthotics or Inserts. Some IT band trouble can be helped by using either custom or commercial orthotics, particularly if you have high arches.
  4. Replace Running Shoes. Running in old, worn shoes can increase IT band pain, so switch out your shoes at regular intervals.
  5. Avoid Overtraining. Training too much or too often can make any aches and pains worse, so rest and recover after hard workouts.
  6. Cross Train. Doing the same thing over and over makes recovery more difficult. Mix up your training to balance out your body.
  7. Get Adequate Rest and Recovery. Frequent high-intensity workouts can do more harm than good. Learn how rest can improve your training.
  8. Try Backwards Running to correct muscle imbalance and reduce pressure on the knees.
  9. Run on a soft, level surface or alternate directions on the road to avoid stressing the IT band.

IT Band Friction Syndrome doesn't have to be a chronic, debilitating problem. A little bit of prevention and careful diagnosis of the cause can lead to a complete and full recovery.


R Khaund, M.D. and S Flynn, M.D., Iliotibial Band Syndrome: A Common Source of Knee Pain, the American Academy of Family Physicians, April 15, 2005.

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