Written by Kim Grundy, PT | Reviewed by Sanjai Sinha, MD
Published on May 25, 2023
Key takeaways:
IT band syndrome is a common cause of lateral (side) knee pain that often affects runners and cyclists.
Treatment for IT band syndrome involves rest, stretches, hip-strengthening exercises, and ice to decrease inflammation.
Be patient and consistent with your exercises, as it can take up to eight weeks to see improvement.
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Knee pain is a common complaint. Your specific symptoms, including the location of your pain, can provide clues about the cause and best treatment options. If you have aches and pains on the outer side of your knee, especially after running or cycling, you may be experiencing iliotibial (IT) band syndrome.
The iliotibial band, or IT band, is a thick piece of fibrous connective tissue on the outer side of the leg. It starts at the hip and ends at the top of the shinbone, below the knee joint. It helps move and stabilize your hip and knee.
IT band syndrome is a leading cause of lateral (side) knee pain. Experts say it is a top overuse injury among runners. But anyone, including non-athletes, can develop IT band syndrome.
What does IT band syndrome feel like?
The most common symptom of IT band syndrome is pain in the outer knee. Initially, you might only experience discomfort after working out. But eventually symptoms –– such as tenderness, aching, or a burning sensation –– might also occur during exercise.
Other symptoms may include:
Lateral knee pain that extends up to the side of your hip
Lateral knee pain that worsens with specific exercises or movements, such as running or jumping
Pain that starts at at about the same point in every run
Pain while running downhill
Clicking, popping, or snapping when you bend and straighten your knee
Warmth and redness on the outside of your leg
Other conditions can cause lateral knee pain, but they often have different symptoms. For example, with a lateral meniscus tear, you usually also have knee swelling and difficulty straightening your leg.
Make sure to see a medical professional for an accurate knee pain diagnosis.
What causes IT band syndrome?
IT band syndrome is often seen in athletes whose sports involve repeatedly bending and extending the knee, such as runners, cyclists, and soccer players. Experts haven’t pinpointed the exact cause of IT band syndrome. But there are several theories.
One theory is that when the IT band is too tight, it rubs against a bone (the lateral femoral epicondyle) during knee flexion and extension. This results in friction, pain, and inflammation. Other experts think the syndrome happens when the IT band compresses the tissues beneath it, causing pain and inflammation. A third theory suggests that inflammation of fluid-filled sacs (bursitis) near the knee joint leads to IT band syndrome.
Whatever the cause, various risk factors may make you more likely to develop IT band syndrome. These include:
Genetics: People with a smaller pelvic width and more bony prominence on the knee or femur bone (the lateral femoral epicondyle) may be more prone to IT band syndrome.
Anatomy, joint alignment, or musculoskeletal conditions: Flat or overpronated feet, knee varus (bowlegs), or knee valgus (knock knees) can increase the risk of IT band syndrome. Knee arthritis may increase the likelihood of developing IT band syndrome.
IT band stiffness: Decreased IT band flexibility can cause friction or compression.
Skipping your workout warm-up: When you don’t prime your muscles for exercise, it increases the likelihood of injuries and issues like IT band syndrome.
Weak hip, knee, and gluteal muscles: Muscle weakness can trigger imbalances and increase strain on the IT band.
Training surfaces: Running downhill or consistently running in the same direction on a tilted track can contribute to IT band syndrome.
Overtraining: Increasing the intensity or volume of exercise without taking enough rest days can lead to IT band syndrome and other problems that will slow your progress.
How do you treat IT band syndrome?
It is important to be patient and consistent when you’re recovering from IT band syndrome, as it doesn’t go away quickly for most people. According to some estimates, only 44% of people fully recover from IT band syndrome after 8 weeks of conservative treatment. Up to 90% of people may fully recover after 6 months.
A 2022 review found that the following IT band syndrome treatments do help. But more research is needed.
Rest
Reducing or modifying your activities can help heal inflammation. You may need to stop aggravating exercises like running or cycling for up to 6 weeks, depending on your IT band syndrome symptoms. That doesn’t mean you have to stop exercising altogether. You can try activities that don’t irritate your IT band, such as swimming, yoga, or Pilates.
Cold therapy
Cold therapy has been shown to lower pain sensitivity and reduce swelling. You can try applying an ice pack for 10 to 20 minutes when your IT band starts hurting. Repeat every few hours, as needed. Just be sure not to apply the ice directly to your skin.
A short course of non-steroidal anti-inflammatories (NSAIDs)
Over-the-counter NSAID medications, such as naproxen (Aleve) and ibuprofen (Advil or Motrin), can also help ease symptoms. Remember that OTC pain relievers are intended for short-term use. Talk to your doctor if you need to take them for more than 10 days in a row.
IT band stretches and exercises
IT band stretches and exercises are an important part of treatment. Strengthening moves that work the gluteal and hip abductor muscles have been shown to ease IT band pain. It is also important to focus on muscular endurance, as too much emphasis on strength could make the IT band tighter. So you might want to do more reps with lighter weights and shorter rest times.
Because the IT band is fibrous connective tissue, the flexibility won’t increase much with stretching. But stretches that target nearby muscles –– such as the tensor fascia latae in the hip –– can relieve tension and pressure on the IT band.
Try doing a few minutes of static stretching after your warm-up and strengthening exercises. Remember to cool down afterward.
Massage therapy
A physical therapist or massage therapist may use soft tissue techniques to help manage IT band syndrome in the early stages. Examples include massage, trigger point release, and myofascial release. Foam rolling is not recommended, as it can be painful and may increase symptoms. In addition, a 2021 study found that foam rolling did not help with IT band stiffness.
Gradual return to activity
A gradual return to your usual activities is important to avoid a flare-up of symptoms. For example, runners should consider starting on a flat surface and slowly increasing distance, as long as it’s pain-free. After running for 3 to 4 weeks on a flat surface without pain, you can add mileage and hills as tolerated.
If symptoms don’t improve after six months of conservative treatment, there are surgical options. They include IT band release, IT band–lengthening bursectomy, and arthroscopic IT band debridement.
Can you prevent IT band syndrome?
It can be hard to prevent IT band syndrome if you have genetic risk factors that are beyond your control. You might need to switch up your exercises and try lower-impact options like swimming or yoga instead of running or cycling daily.
The following tips can also help:
Warm up before exercise and include active or dynamic stretches.
After exercise, do static stretches and include IT band stretches.
Use ice on your IT band after exercise to prevent inflammation.
Maintain a strength training routine that includes lower-body exercises.
Stop or modify your activity if you start having IT band pain.
Wear supportive footwear.
If you are a runner, it helps to be aware of your running form and training technique. It can be a good idea to:
Stick with shorter sprints rather than long runs
Avoid hard surfaces
Avoid running in the same direction on a track each time, as the angled circuit can put stress on your IT band
Avoid running on hills, especially downhill, if it increases pain
Take adequate rest days between runs
Replace your running shoes every six months or 300 to 500 miles, whichever comes first
Many of these strategies — particularly the ones that involve rest and proper form — apply to all athletes and exercisers.
The bottom line
IT band syndrome is a common condition that often affects athletes whose sports require repetitive knee flexion and extension, such as runners, cyclists, and rowers. Symptoms include pain on the side of the knee, which may get worse with exercise.
Many people will see an improvement after 8 weeks of conservative treatment, such as rest or activity modification, IT band stretches, and hip-strengthening exercises. So IT band syndrome doesn’t have to slow you down for good.
References
Beals, C., et al. (2013). A review of treatment for iliotibial band syndrome in the athletic population. Journal of Sports Medicine.
Benca, E., et al. (2020). Analysis of running-related injuries: The Vienna Study. Journal of Clinical Medicine.
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