Updated: May 5
Iliotibial band syndrome (IT band syndrome) can be a pesky problem to get rid of, and its one of the few injuries that affect more male runners than females. I actually did my masters dissertation on this subject and found that, like with most sports injuries, IT band syndrome can have many causes. And the key to finding an effective treatment plan for your case lies in figuring out exactly what caused yours. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
We also made a video about this:
Anatomy of the IT band
The Iliotibial band (IT band or ITB) is made of thick fibrous fascia that is extremely strong. Facia is the white sinewy stuff that you find in meat. It may help to imagine it as the same material that a car’s safety belt is made of.
It runs from the top of the pelvis over the side of the hip, down the side of the thigh and attaches to the outside of the knee and kneecap.
The IT band itself is sinewy and not very flexible, and it’s not really possible to stretch it. I know! You’ve been taught stretches for the IT band in the past, but give me a moment to explain.
There are several muscles that attach into the IT band, including the Glute Max, Tensor Fasciae Latae, and Lateral Quadriceps muscle. If these muscles become tight and inflexible, they pull the IT band taut and then people wrongly blame the IT band for being 'too tight'. In fact, it’s the fault of the muscles that are attached into the IT band.
So, instead of trying to stretch the IT band, it works much better if you direct your stretches at the muscles that attach onto it. I’ll give you some examples later in the article.
What does the IT band do?
It helps to stabilise your pelvis (keeps it level) on your leg when you walk or run or jump. As mentioned above, the IT band itself cannot contract, but it can get pulled tight when the muscles that attach into it contract and tug on it.
What causes IT band syndrome?
IT band syndrome is caused when the IT band is pulled too tight over the outside of the knee, causing it to squash excessively against and rub on the bone as you bend and straighten your knee during running. Traditionally, IT band syndrome was described as being caused by excessive friction, but these days researchers think it may actually be due to excessive compression.
This not only causes the IT band itself to become inflamed and sore, but also the fat pad and bursae between the IT band and the bone. A bursa is a small fluid-filled sac, and you find them everywhere in the body where tendons and bones are close to each other. Their job is to decrease friction, but they can become inflamed and very painful when exposed to excessive compression or friction.
Interestingly, researchers have reported that when they scan the painful area of the IT band, they most often find that it is this tissue (fat pad and bursae) between the IT band and the thigh bone that shows signs of injury, rather than the IT band itself.
Some of the reasons why the IT band may be pulled too tight include:
If the muscles that attach into the IT band (glute max, TFL, lateral quad) are tight and pull it too taut.
If your hip muscles aren’t strong and allow your pelvis to drop or your knee to turn in excessively as you run – the glute max and glute med muscles are usually the main culprits. Because the IT band attaches onto the pelvis and knee, it gets pulled tight when this happens.
Excessive pronation in your foot (when your foot rolls in) can cause your lower leg to turn in more. Because the IT band attaches onto the lower leg, this can potentially cause the IT band to pull tight and compress more against the outer knee.
If you’ve done a really tiring run, e.g. a long downhill race. You may normally have strong hip muscles, but if you tire them out a lot, they may not be able to stabilise the pelvis, also causing it to drop and pull the IT band taut.
Downhill running can cause trouble. I’m often guilty of just letting go and plonking down a hill, but this can cause a lot more impact on your legs.
Running on an incline or camber of a road can also cause the IT band on your one leg (the one at the top of the camber) to pull tight over the side of your knee.
If your one leg is shorter than the other, it can cause the IT band of the longer leg to pull tight.
Iliotibial band syndrome symptoms
When you have IT band syndrome, you may feel a sharp or burning pain on the outside of your knee. It usually only hurts while you're running, but if it's very irritated, even walking may make it hurt.
The point in the running gait cycle when the IT band compresses most against the thigh bone is just after your foot touches the ground and when your knee is flexed at about 30 degrees. So, you will likely experience the most pain at that point and then less during the rest of the movement.
You will likely be able to locate a painful area in the lower part of the IT band close to where it attaches to the outer knee. A test we do in clinic to test for IT band syndrome involves us pressing down on the IT band (increasing compression) in the area of the knee and then repeatedly flexing the patient's leg through 30 degrees of knee flexion. This will usually elicit pain if their IT band and the structures under it are irritated.
You may initially only feel the pain towards the end of a run or training session. But if you've ignored it for a while and continued to train through it, it may be painful right from the start of your run.
You may notice a slight puffiness over the outside of the knee, but this is not the case for everyone.
How long does IT band syndrome take to recover?
If you’re lucky and you treat it right from the start, it will take between 6 and 12 weeks. If you neglect it and try to run through it for a while, it can take a lot longer. If you want it to recover quickly, get some guidance and a treatment plan early on from someone who knows what they’re talking about.
What treatments work for IT band syndrome?
As we have seen, IT band syndrome can have many causes, and that’s why there is no one-size-fits-all treatment for it. You have to identify your cause and work on that.
This is key to getting rid of IT band syndrome. You have to cut out all aggravating activities so that the irritated tissue can settle down. This doesn’t mean that you necessarily have to stop running. Some of our patients find that they just have to keep their runs short or play with their running style. For example, running up stairs is often tolerated better than running on the flat.
If you find that you can’t run, you can try and maintain your fitness by doing other activities, like swimming with a pool buoy between your legs. Cycling is often not that well tolerated during the early stage of rehab, because it involves too much repetitive movement in the knee.
Anti-inflammatory medication (NSAIDS)
Using anti-inflammatory medication (like ibuprofen or naproxen) may be useful during the early stages of treatment, as it is thought to reduce the inflammation in the fat pad. Please discuss this with your doctor before you take any medication, because it may not be right for you and can cause other issues.
This should not be seen as a cure. Medication may decrease your pain, but if you want to get rid of IT band syndrome and prevent it from coming back, you have to address the underlying causes discussed above.
Icing the painful area on the side of your knee may be a useful way to decrease pain and inflammation in the fat pad when you have IT band syndrome. Just like with anti-inflammatory medication, ice should not be seen as a cure. It might be a useful short-term solution to help calm the sensitivity down, but you still have to address the underlying causes.
You can read more about how to use ice for sports injuries in this article.
Exercises like single leg squats or lunges are usually not useful at the start, when the IT band is still very sore. Leave them for later and choose exercises where the knee stays stationary (e.g. the clam or double leg glute bridge) to start with.
Strength training alone may not be enough to improve your movement patterns when you run. Research has found that runners often have to do specific running style drills if they want to improve the way their legs move when they run. We discuss running tips for IT band syndrome in more detail in this article.
Whilst the IT band itself cannot really be stretched (it's too sinewy), you may find benefit from stretching the muscles that attach onto the IT band. These include the glutes, TFL, and lateral quad.
Stretching these muscles reduces their tone, which in turn reduces the pull on the IT band. Getting into the habit of stretching these areas after you've done a workout may be a useful way of preventing them from becoming overactive and tight.
Just make sure that, during the early stages of rehab when your knee is still very painful, you choose stretches that don't put a lot of strain on the injured area. We'll discuss this in more detail in a future blog post.
Massage and foam rolling
Physios will often use massage as part of their treatment for iliotibial band syndrome or recommend that patients use a foam roller. This can be useful, as it can help reduce pain and relax the muscles that attach onto the IT band. But the positive effects, both from massage by a therapist as well as self-massage using a foam roller, are transient.
So massage/self-massage can be useful during the early stages to help reduce pain and discomfort, but it too is not a cure.
Please don't hammer the poor IT band when you foam roll. Remember, this injury is caused by too much compression, and you will make your symptoms worse if you are too aggressive. Rather massage all the muscles that attach onto the IT band (glute max, TFL, lateral quad). I discuss all the dos and don'ts of foam rolling the IT band and the relevant muscles in this article.
The research has shown that changing your running style to giving lighter, quicker steps can work well to treat ITB syndrome. Increasing your cadence (how many steps you take in a minute) by as little as 5% can significantly reduce the impact forces on your body when you run.
We've written a whole article just about running with IT band syndrome where you can find more tips and advice about this.
Orthotics or supportive insoles
You may benefit from wearing some orthotics or supportive insoles if you have one leg shorter than the other or if your feet roll in too much (over-pronate) when you run. I would consult a podiatrist if you have a leg length difference, but below are some affiliate links to orthotics on Amazon that may help correct over-pronation.
Note: Commission may be earned on the links above.
IT band straps/braces
Some of my patients have found that using IT band straps or braces helped them. They work by changing how the IT band makes contact with the bone. For some people this can off-load the painful part and allow them to train pain-free.
Are you causing more damage by using them? I usually advise people to see how they feel within the next 24 hours. If, when using the IT band support, they are pain-free during their run and their symptoms are no worse during the 24 hours after the run, they are very likely OK to use it. If, however, they find that their pain is significantly worse after their run or the next morning, I would say that they are better off not using the support.
Below are some affiliate links to examples of IT band braces/straps on Amazon.
Note: Commission may be earned on the links above.
In summary: Every person’s case of IT band syndrome will have a specific set of factors that caused it and your treatment plan needs to address all of them.
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait re‐training emphasizing step rate manipulation. International Journal of Sports Physical Therapy 2014;9(2):222.
Balachandar, V., et al. (2019). "Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment." Muscles, Ligaments & Tendons Journal (MLTJ) 9(2).
Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526.
Louw, Maryke, and Clare Deary. "The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–A systematic review of the literature." Physical Therapy in Sport 15.1 (2014): 64-75.